Health Scan: Surgery still sometimes needed to get rid of kidney stonesSome people know that if a person is diagnosed with kidney stones, he can be tr

Some people know that if a person is diagnosed with kidney stones, he can be treated non-invasively with a soundwave device called a lithotripter, which smashes the stones into tiny fragments. Another technique is to insert an optic fiber into the urinary tract to destroy the stones. But Dr. Mordechai Duvdevani of the andro-urology unit at Hadassah University Medical Center in Jerusalem's Ein Kerem notes that these treatments are not so simple, and that the condition may still require minimally invasive surgery.

Writing in the latest issue of Urology Updates published by Medical Media, Duvdevani says these procedures are sometimes not successful - especially when stones are larger than 20 millimeters in diameter or very dense. In some cases, the fragments don't flush out of the body. Instead, a better technique, called percutaneous nephrolithotomy, is recommended.

The urologist explains that kidney stones result when there are bacteria able to break down uric acid and allow minerals to accumulate in the urinary tract. Antibiotics are not enough to get rid of these stones, as layer after layer of minerals accumulate. Sometimes, kidneys that are congenitally shaped differently than the norm are more prone to stones.

In percutaneous nephrolithotomy, which is performed under general anesthesia in one to four hours, a path is created to the kidney via the hip. Ultrasound, laser or other energy-based devices are introduced to smash the stones in situ and "vacuum" them out. Sometimes a supportive stent in inserted into the urethra that remains for a day or two. The procedure takes so long because the path must be at exactly the right location, angle and size. Sometimes a second path has to be created. The patient is hospitalized for two days to a week. Serious complications, writes Duvdevani, are rare.

Nephrolithotomy can be used by a well-trained team on a wide variety of patients, he concludes, including those with chronic illness and anatomical changes in the urinary tract. As kidney stones can recur, patients should be followed up.