Kidney Stone Treatments

Mantu Gupta, MD, is Director of the Kidney Stone Center at Mount Sinai. In addition to monitoring and prescribing medications to aid in the expulsion or dissolution of small stones, he and his team utilize a variety of noninvasive and minimally invasive procedures to remove kidney stones based on the size and type, a patient's unique health profile, and his or her preferences for intervention. Dr. Gupta also employs a nutritional, holistic and preventive approach to the management of stone disease to ensure comprehensive and personalized care.

Treatment for Small Kidney Stones

Not all kidney stones need surgical treatment. Stones that are small and are possibly able to pass spontaneously can be safely observed in the absence of severe pain, nausea, vomiting, swelling of the kidney (known as hydronephrosis), or infection. If a small stone is in the ureter, medical therapy with an alpha antagonist has been shown to speed the passage of the stone and also decrease the amount of pain and the need for narcotic analgesics, and our own research supports this.

Small, asymptomatic stones in the kidney can also usually be safely observed, if they are deemed to be passable. Medical evaluation can identify individual factors that can be addressed by dietary changes, the use of vitamins or supplements, or, if necessary, medications that will prevent stone growth or can result in stone dissolution.

Extracorporeal Shock Wave Lithotripsy (ESWL)

Extracorporeal shock wave lithotripsy (ESWL) is a noninvasive outpatient treatment for small kidney stones utilizing a high voltage device that generates high-energy shock waves that enter the body through the skin surface without an incision. The shock waves are focused onto the stone and the stone is fragmented into particles, which can then be passed in the urine.

Dr. Gupta through his research has pioneered many of the methods and strategies currently used to determine who is a good candidate for ESWL and how to maximize effectiveness while improving patient safety. One such method involves measuring the distance the shock waves have to travel to reach the kidney stone. Dr. Gupta showed that the longer the distance (called the skin to stone distance, or SSD), the lower the success. In separate research, Dr. Gupta showed that obesity, measured by bioimpedance, results in decreased effectiveness. He also showed that utilizing an escalating voltage strategy, whereby lower voltage is used initially and gradually ramped up, results in better stone fragmentation and less kidney injury. Another investigation showed that administering a diuretic called mannitol to patients who have partial kidney failure prior to ESWL protects the kidney. Dr. Gupta also demonstrated that patients who have larger stones but are not candidates for more invasive therapies can still be treated with ESWL by placing a sheath into the kidney that allows fragments to be flushed out during the treatment, so the large number of fragments do not cause blockage when trying to pass out following the procedure.

Mount Sinai has a new state-of-the-art technologically advanced lithotripsy device located at the Mount Sinai Roosevelt Hospital location that is available five days a week for the expedient treatment of kidney stones in our patients.

Ureteroscopic Laser Lithotripsy (URSLL)

Ureteroscopic laser lithotripsy (URSLL) is a minimally invasive outpatient surgical technique that is completely endoscopic and uses natural body orifices to directly visualize and treat kidney stones located in the ureter or the kidney. A small endoscopic camera is passed through the urethra and urinary bladder into the ureter and/or kidney and then a Holmium:YAG laser is used to fragment the stone into particles that can be extracted from the body, so there is no need for the patient to pass them. Dr. Gupta has shown that the results for URSLL are superior to ESWL for stones in the upper part of the ureter that are larger than one cm. He also demonstrated that even morbidly obese patients can be treated with URSLL without compromising results.  
We are fortunate at Mount Sinai to have endoscopes employing the latest digital technology and state-of-the-art Holmium laser machines. In addition, Dr. Gupta has tested and helped design many of the devices used today.

Percutaneous Nephrolithotomy (PCNL)

Percutaneous nephrolithotomy (PCNL) is a minimally invasive technique for the removal of large kidney stones. A small keyhole opening is made in the patient’s side and a sheath is placed into the kidney. A camera placed through the sheath visualizes the stones, and they are fragmented using a pneumatic or ultrasound device and then removed. Dr. Gupta is renowned for this type of surgery and has taught this procedure to other urologists throughout the world for almost 20 years. He has pioneered less invasive techniques of PCNL, including a new procedure in which the opening that is made is only eight mm (less than 1/3 of an inch), resulting in less pain and quicker recovery without changing the success rate.

Follow-up Care

Approximately two-thirds of patients who have had one kidney stone are at risk for developing another kidney stone in the future. Because of this high rate of recurrence, Mount Sinai physicians recommend a metabolic evaluation, which includes stone analysis, blood, and urinary testing. Additional testing, including the use of bone density measurements, is sometimes required. This evaluation identifies the source of problems in more than 90 percent of patients and is invaluable for optimal management planning.

Dietary changes (which vary from person to person) and/or supplements and vitamins can also help to decrease future stone formation. Our physicians have tremendous experience in the evaluation of risk factors of stone disease and the nonsurgical treatment of kidney stones.

Our Kidney Stone Center prides itself in its holistic approach to the kidney stone patient. This involves consultation with a nephrologist experienced in the causes and prevention of kidney stone disease, a dietitian who can provide a detailed evaluation of a patient’s nutritional needs and can create a personalized plan that will help prevent kidney stones while maintaining a balanced and heart-healthy diet, an alternative medicine specialist who can help find alternatives to medicines and invasive procedures, and an endocrinologist who can evaluate bone health, especially in women at risk for osteopenia and osteoporosis. Our team also performs periodic evaluation with state-of-the-art non-invasive imaging to monitor kidney stones that do not need removal and to observe for new stone formation, since early detection can avert a painful kidney stone attack.

 


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Kidney Stone Treatment

Mantu Gupta, MD, Director of the Kidney Stone Center at Mount Sinai, discusses innovative and non-invasive options for the treatment and management of kidney stones. Watch this video