Urology’s Nishant Patel, MD, was featured in The Daily Progress with his article “Ask the Expert: Fighting kidney stones with research, treatment.” The article appears below:
Our state is a key member of the infamous “Stone Belt” in America: About 12% to 15% of Virginians develop kidney stones at some point in their lives. We’re not entirely sure why: These rocky masses grow inside us thanks to a combination of genetic, environmental and dietary factors that are particularly prevalent in this part of the country. But regardless of how they’re formed, kidney stones can be terribly painful once they are blocking the kidney.
Here’s the good news. Scientists have developed some extraordinary technology to treat kidney stones, and we have it right here in Charlottesville. UVA Health’s urology department has always been an early adopter of technologies to pulverize or extract kidney stones, and we’re conducting world-class research on better potential treatments.
Most stones that cause intense pain become lodged in the ureter, the tube connecting the kidney to the bladder. While smaller stones are able to spontaneously pass through the urine, others require surgery. Some stones are so large that they become stuck in the kidney and cause pain, infections, kidney injury and blood in the urine.
Before modern medicine, a simple kidney stone caused fairly high rates of death. Thanks to advances in surgical technology and techniques, that’s rare now. UVA has long been on the forefront of treating kidney stones, as it was among the first institutions to use an extracorporeal shock wave lithotripter. Known as the Dornier HM-3, the machine was installed at UVA in 1984 and treated thousands of patients until its decommissioning in 2018. This widely used tool directs shock waves from outside the body to target kidney stones. Essentially, the kidney stones are blasted into tiny pieces that can be flushed easily from the body. But kidney stone science has advanced well past these devices.
A surgical procedure called ureteroscopy deploys a very thin scope, through which a high-powered laser breaks up the stone under direct vision, so we know we are treating the entire stone. It’s a quick, outpatient procedure – and UVA is in the process of installing a new laser system that offers even quicker stone destruction. Another tool in our urological arsenal is percutaneous nephrolithotomy, a surgery typically reserved for larger stones. We carefully thread a needle and wire under the patient’s ribcage to gain access to the kidney. We then use this wire to place a larger sheath for direct access inside the kidney to remove the stone. Traditionally, due to the bleeding risk from larger sheaths, patients were admitted to the hospital for one to two days. The sheaths and scopes used for this surgery are becoming smaller and smaller, which help makes the surgery safer, less painful and enables patients to go home the day of their procedure.
Researchers at the UVA Health Comprehensive Stone Center are working to better understand why more and more people are getting kidney stones, particularly in our region, and hopefully prevent future stone episodes. At the stone center, we gather endourologists and nephrologists to determine why patients develop stones with the use of 24-hour urine collections. We can then give dietary advice or, sometimes, medications to prevent another stone episode, since kidney stones often recur.
Dr. Nishant D. Patel is an endourologist at UVA Health specializing in kidney stones. For more information, please visit uvahealth.com/services/kidney-care/kidney-stones.