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Last Modified - 12/17/2010
Kidney and Ureteral Stones
Kidney stones are small crystallized structures that can form as a result of an imbalance of certain
components in urine such as calcium, oxalate and phosphate. They can also be caused as a result
of a urinary tract infection or hereditary factors. With more than a million cases diagnosed each year,
kidney stones are among the most painful and most common disorder of the urinary system. It is
estimated that 10 percent of Americans will acquire them during their lifetime. While many kidney
stones pass without the need for medical intervention, when it is needed, El Camino Urology Medical
Group is ready to provide compassionate state-of-the-art care for improved outcomes, enhanced
patient comfort and rapid recovery.
Diagnosing Kidney Stones
Routine x-rays taken during physical examinations can discover kidney stones in patients where no
symptoms are evident. More frequently, kidney stones are found as a result of a diagnostic imaging
examination (abdominal/pelvic CT scan) ordered for patients manifesting symptoms such as blood
in the urine and/or sudden and intense back (flank) pain. Additionally, blood and urine tests are used
to detect compounds or substances that suggest the presence of kidney stones and conditions that
can promote their formation.
El Camino Urology Medical Group uses a variety of approaches to treat patients with kidney stones.
For more complex stones (such as cystine or staghorn stones) or urologic disease, Dr. Frank Lai is
one of the few fellowship trained minimally invasive endosopic, laparoscopic, and robotic surgery
urologists in the Bay area. Treatment can range from hydration and painkillers to minimally invasive
non-surgical and surgical procedures to remove the stones or facilitate their passage through the
urinary system. Option may include:
Extracorporeal Shock Wave Lithotripsy (ESWL):
This minimally invasive, non-surgical outpatient procedure focuses ultrasonic shock waves through
a patient’s skin and tissue and onto the kidney stones. As the shock waves impact the stones, they
break them into minute particles which can be easily passed through the urinary tract in the urine.
This procedure requires no anesthesia and most patients resume normal activities in several days.
Large kidney stones may require more than one lithotripsy treatment.
This minimally invasive procedure is also used to treat stones in the ureters. Since it does not
require an incision, it involves inserting a fiberoptic ureteroscope directly into the opening in the
urethra, through the bladder and into the ureter. Through it, a physician can view the stone and pass
instruments to remove or fragment it. This is a day surgery procedure that involves anesthesia and
placement of a stent in the ureter while healing takes place.
Minimally Invasive Retrograde Intrarenal Surgery (RIRS):
This procedure permits surgery to be performed inside the kidney without making an external
incision. It is an outpatient procedure where a viewing tube, called a fiberoptic endoscope, and
instruments for performing the surgery are inserted through the opening in the urethra, and moved
through the bladder and the ureter and into the kidney. The procedure is for children and patients in
general with kidney stones, narrowing of the outlet of the kidney, urethral strictures (scarring) and
kidney tumors, as well as patients with bleeding disorders or who are overweight. The procedure
involves the use of local, intravenous or general anesthesia.
Percutaneous Nephrolithotomy (PNL):
This minimally invasive surgical procedure is for larger stones located in the ureters where externally
administered lithotripsy cannot be used effectively or where the stones cause a blockage that cannot
be bypassed by a stent. The ureters are anatomical structures descending from the kidney to the
bladder. The procedure involves a small incision in the patient’s flank into which a nephroscope is
inserted to locate and physically remove the stone. In certain situations larger stones may be broken
into smaller pieces through the use of an energy probe (i.e. ultrasound) inserted through the incision.
The entire procedure requires sedation or anesthesia and a short hospital stay.
The comprehensive level of care provided by the El Camino Urology Medical Group includes helping
patients manage their disease and prevent recurrence. Once your stone has been treated or has
passed spontaneously, we will analyze the stone and your urine using a simple at home 24 hour
urine collection to determine why you are making kidney stones. Based on the results, the
physicians at El Camino Urology Group will offer a customized treatment plan that could include
simple dietary changes, increasing fluid intake, and medications. We believe in the saying, “an
ounce of prevention is worth a pound of cure.”
Ureteroscopy allows for precise
visualization of kidney stones in any
part of the urinary system.
Powerful laser energy is delivered
through tiny fiberoptic wires that can
be placed through the channel of the
ureteroscope to break even the
hardest stones into small fragments.
These consecutive images obtained
during surgery show how the stone is
shaved down to a smaller size with
the laser energy delivered through the
After the stone has been adequately
fragmented only small pieces remain
that can easily pass out of the ureter
without causing any pain or
Larger pieces can be manually
removed using tiny "baskets" that also
fit through the channel of the
ureteroscope. The entire surgery is
performed without any incisions or
Video: Ureteroscopy and Laser Lithotripsy at El Camino Urology