Our Kidney Stone Treatment Philosophy

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• Remove

• Evaluate

• Prevent

 

 

• Kidney stones are more than an isolated event. For many patients, they are part of an ongoing condition that can recur over time.

• When a kidney stone requires treatment, the immediate priority is to safely and effectively remove the stone. But comprehensive stone care should not stop there. Understanding why the stone formed can provide an opportunity to reduce the risk of forming another one.

• My approach to kidney stone care is built around three principles:

Remove Evaluate Prevent

• REMOVE the stone using the treatment that is appropriate for its size, location, number, composition, and your individual anatomy.

• EVALUATE the stone and your metabolic risk factors to better understand why you formed it.

• PREVENT future stones by developing a personalized strategy based on your individual risk factors.

• As one of the first physicians in Florida to perform CVAC™ suction ureteroscopy, I offer this advanced technology as part of a comprehensive approach to kidney stone treatment.

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REMOVE

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Advanced Options for Kidney Stone Removal

• Not every kidney stone requires the same treatment.

• Some small stones can safely pass on their own and may simply require observation, medication for symptoms, and follow-up imaging. Other stones may cause significant pain, obstruction, infection, bleeding, or other problems and require active treatment.

• When intervention is recommended, treatment options can include CVAC™ suction ureteroscopy, conventional ureteroscopy, extracorporeal shock wave lithotripsy (ESWL), and other surgical approaches.

• The right procedure depends on the individual patient—not simply the size of the stone.

• Factors that may influence treatment include:

• Stone size

• Number of stones

• Stone location

• Stone composition

• Stone density

• Kidney and urinary tract anatomy

• Presence of obstruction

• Symptoms

• Infection

• Previous stone procedures

• Overall health

• Patient preferences

• My role is to evaluate these factors and recommend the approach that is most appropriate for your situation.

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CVAC™ Suction Ureteroscopy

Advanced Technology for Stone Fragment Removal

• CVAC™ suction ureteroscopy represents an evolution of ureteroscopic kidney stone treatment.

• Ureteroscopy allows a physician to directly access stones through the natural urinary tract. A small flexible scope is passed through the bladder and ureter into the kidney, allowing the stone to be visualized and treated.

• When laser lithotripsy is used, the laser breaks the stone into smaller fragments.

• CVAC adds active suction to this approach, allowing stone fragments, debris, and irrigation fluid to be aspirated during the procedure.

• The combination of direct visualization, laser treatment, irrigation, and active aspiration provides another tool for managing kidney stone burden.

My Experience With CVAC

• I was one of the first physicians in Florida to perform CVAC suction ureteroscopy.

• As an early adopter of the technology, I have incorporated CVAC into my kidney stone practice when I believe it is an appropriate option for a particular patient.

• New technology is valuable when it can meaningfully improve the treatment experience or expand the options available to patients. At the same time, no single procedure is ideal for every stone.

• My recommendation is based on your individual anatomy, imaging, stone characteristics, medical history, and treatment goals.

How CVAC™ Works

• During CVAC suction ureteroscopy, a small flexible ureteroscope is advanced through the urinary tract and into the kidney.

• The stone can be treated with laser energy to break it into smaller pieces. The CVAC system incorporates controlled suction that can help remove stone fragments and debris from the kidney.

• The procedure allows the physician to continuously visualize the treatment area and work toward clearing the stone burden.

• Because the procedure is performed through the urinary tract, there is generally no external incision.

• Depending on the circumstances, a temporary ureteral stent may be placed following treatment.

Potential Benefits of CVAC™

• CVAC provides active suction during ureteroscopic stone treatment and may offer advantages for appropriately selected patients.

• Potential benefits may include:

• Active aspiration of stone fragments

• Removal of debris during treatment

• Evacuation of irrigation fluid

• Direct visualization during stone treatment

• A minimally invasive approach through the urinary tract

• An additional option for patients with significant or complex stone burdens

• The benefits and limitations of CVAC depend on the individual patient and stone characteristics.

• It is important to understand that CVAC is not automatically the best treatment for every kidney stone. In some situations, another treatment may provide a better balance of effectiveness, safety, convenience, and recovery.

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Ureteroscopy

Direct Visualization and Treatment

• Ureteroscopy is a minimally invasive procedure that allows stones in the ureter or kidney to be treated directly.

• A small scope is passed through the urethra and bladder into the urinary tract. Once the stone is identified, laser energy can be used to fragment it. Stone fragments may then be removed with specialized instruments or allowed to pass, depending on their size and the circumstances of the procedure.

• Ureteroscopy is particularly useful because it allows the physician to directly see and treat the stone rather than relying on external energy to reach it.

 

CVAC and Ureteroscopy

• CVAC is performed as part of a ureteroscopic approach.

• The key distinction is the addition of active suction to assist in removing stone fragments and debris.

• For appropriately selected patients, this can provide another option for managing stone material during ureteroscopy.

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ESWL

 

Extracorporeal Shock Wave Lithotripsy

• ESWL is a non-invasive treatment that uses focused shock waves generated outside the body to break a kidney stone into smaller fragments.

• Unlike ureteroscopy, ESWL does not require a scope to be passed into the kidney to treat the stone.

• Once fragmented, the pieces can pass naturally through the urinary tract.

• ESWL can be an effective option for certain kidney stones, but it is not appropriate for every patient or every stone.

• Its effectiveness can be influenced by:

• Stone size

• Stone location

• Stone density and composition

• Distance from the skin to the stone

• Kidney anatomy

• Other patient-specific factors

• One of the advantages of a comprehensive evaluation is being able to compare these factors and determine whether ESWL, ureteroscopy, CVAC, or another treatment is most appropriate.

 

Ureteral Stents

 

Supporting the Urinary Tract Before or After Stone Treatment

• A ureteral stent is a small, flexible tube placed inside the ureter to maintain drainage between the kidney and bladder.

• A stent may be recommended in certain circumstances before or after a stone procedure.

• For example, a stent may be used when there is obstruction, significant swelling, infection-related concerns, a difficult or narrow ureter, or after certain stone procedures to facilitate drainage while the urinary tract heals.

 

What to Expect With a Stent

• Although stents are commonly used and generally temporary, they can cause symptoms while they are in place.

• These may include:

• Urinary frequency

• Urinary urgency

• Bladder discomfort

• Flank or back discomfort

• Blood in the urine

• Discomfort with urination

• If a stent is recommended, you will be informed about why it is needed, how long it is expected to remain in place, and what symptoms you may experience.

• Stent removal is an important part of the treatment plan, and patients should follow the instructions provided regarding removal or follow-up.

 

EVALUATE

 

Don't Just Treat the Stone. Understand the Stone.

• Removing a kidney stone addresses the immediate problem.

• But kidney stones often have an underlying cause.

• The urine contains a balance of minerals, salts, acids, and other substances. When that balance changes, crystals can form and eventually develop into stones.

• Some people are simply more prone to stone formation than others. Dietary factors, fluid intake, genetics, medications, medical conditions, and abnormalities in urinary chemistry can all play a role.

• That is why, when appropriate, I go beyond treating the stone itself and evaluate the factors that may be contributing to stone formation.

 

Stone Analysis

 

Knowing What Your Stone Is Made Of Matters

• When a stone or stone fragment is available, stone analysis can provide valuable information.

• Kidney stones are not all the same. Common stone types include calcium oxalate, calcium phosphate, uric acid, struvite, and cystine stones.

• Knowing the composition of your stone can help guide further evaluation and prevention.

• For example, the prevention strategy for a patient with a uric acid stone may differ substantially from that of a patient who forms calcium oxalate stones.

• Stone analysis is therefore an important piece of the overall picture whenever a stone specimen can be obtained.

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Metabolic Evaluation

Identifying Why You Form Stones

• For patients who are at increased risk for recurrent kidney stones, a metabolic evaluation can help identify abnormalities that may contribute to stone formation.

• A metabolic evaluation may include blood testing and one or more 24-hour urine collections.

• A 24-hour urine test evaluates the urine over an entire day and can provide information about your individual stone-forming environment.

• Depending on your circumstances, testing may evaluate:

• Urine volume

• Urinary calcium

• Urinary oxalate

• Urinary citrate

• Uric acid

• Sodium

• Urine pH

• Other factors associated with stone formation

• Blood testing may also be used to evaluate relevant metabolic or medical factors.

 

Why a 24-Hour Urine Test?

• A single urine sample provides information about one moment in time.

• A 24-hour urine collection provides a broader picture of what your kidneys are excreting throughout the day.

• This information can help identify patterns that may increase your risk of forming stones.

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Who Should Consider a Metabolic Evaluation?

A metabolic evaluation may be particularly useful for patients with:

• Recurrent kidney stones

• Multiple kidney stones

• A strong family history of stones

• Stones at a relatively young age

• Certain stone compositions

• Bilateral stones

• Certain medical conditions associated with stone formation

• Certain medication exposures

• Other factors suggesting an increased risk of recurrence

• Not every patient requires an extensive metabolic evaluation. Your history and stone characteristics help determine whether testing is appropriate.

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PREVENT

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The Goal Is to Prevent the Next Stone

Once your stone has been removed and your evaluation is complete, the next question is:

• How can we reduce your risk of forming another stone?

• There is no universal kidney stone diet because the factors that cause stones vary from person to person.

• Your prevention plan should be based on your stone type, metabolic evaluation, dietary habits, medical history, and individual risk factors.

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Personalized Stone Prevention

• Depending on your evaluation, prevention may involve recommendations regarding:

 

Hydration

• Increasing fluid intake is one of the most important general strategies for reducing stone risk. The appropriate goal can vary depending on your individual circumstances, activity level, climate, and urinary findings.

Dietary Sodium

• High sodium intake can increase urinary calcium in some patients and may contribute to calcium stone formation.

Dietary Calcium

• Avoiding calcium altogether is generally not the goal. Appropriate dietary calcium can be an important part of a healthy stone-prevention strategy, while the timing and amount may be individualized.

Oxalate

• For patients with elevated urinary oxalate, dietary evaluation may identify foods or dietary patterns that could be contributing to stone formation.

Citrate

• Citrate can inhibit certain types of stone formation. If urinary citrate is low, dietary changes or medication may sometimes be considered.

Animal Protein and Uric Acid

• Dietary patterns involving higher amounts of animal protein can influence urinary chemistry and may be relevant in patients who form certain types of stones.

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Medication

• For selected patients, medication may be appropriate when a specific metabolic abnormality or medical condition increases stone risk.

• The goal is not to place every patient on the same restrictive diet. It is to identify your specific risk factors and address the ones that matter most.

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Follow-Up and Long-Term Stone Care

• Kidney stone prevention is an ongoing process.

• Depending on your individual risk, follow-up may include repeat imaging, laboratory testing, additional 24-hour urine testing, or adjustments to your prevention plan.

• The objective is to determine whether your risk factors are improving and whether additional stones are developing.

• For patients who form recurrent stones, long-term follow-up can be an important part of maintaining kidney and urinary tract health.

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Your Kidney Stone Treatment Should Be Individualized

• There is no single “best” kidney stone procedure for every patient.

• A small stone that is likely to pass may require observation.

• A stone in a favorable location may be appropriate for ESWL.

• Another stone may be better treated with ureteroscopy.

• A patient with a significant or complex stone burden may be an appropriate candidate for CVAC suction ureteroscopy.

• Some patients may require a temporary ureteral stent as part of their treatment.

• And for patients who are prone to recurrent stones, metabolic evaluation can provide information that may help prevent future episodes.

• The right approach begins with understanding your stone and your individual risk profile.

 

 

Remove. Evaluate. Prevent.

 

A Different Approach to Kidney Stone Care

REMOVE

• Treat the stone using the approach that best fits your individual circumstances—including advanced CVAC suction ureteroscopy, ureteroscopy, ESWL, or other appropriate treatment.

EVALUATE

• Analyze the stone when possible and, when appropriate, perform a metabolic evaluation to identify factors contributing to stone formation.

PREVENT

• Use that information to develop a personalized plan focused on hydration, nutrition, lifestyle, and medications when appropriate to reduce the risk of future stones.

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Because treating the stone is only the beginning.

• My goal is not simply to help you get through your current kidney stone episode. It is to provide a comprehensive, personalized approach to kidney stone care—removing the stone, evaluating the factors that may have caused it, and developing a strategy to help prevent future stones.

• Remove. Evaluate. Prevent.

• That philosophy guides every aspect of my approach to kidney stone treatment, from advanced stone removal with CVAC™ suction ureteroscopy to metabolic evaluation and individualized strategies for long-term stone prevention.