Emerging Technologies for Treating Kidney Stones

Every year, roughly one million people are treated with kidney stones, and one in ten people will experience kidney stones at some point in their life. And, although common, kidney stones can be quite painful. Regardless of size and location, seeking treatment is important, as large stones may require surgery. Luckily, over the years, innovative technologies have continued to develop to improve the efficiency of kidney stone treatment while decreasing discomfort. Here, we'll go over a few emerging technologies for treating kidney stones.

What to Know About Kidney Stones

Kidney stones are small, hard deposits of minerals and salts inside the kidneys. When the minerals and salts in the urine become concentrated and crystallize, they can form stones. The stones can vary, ranging from tiny crystals to large masses as big as a golf ball.

You may develop a kidney stone for several reasons, so getting a proper diagnosis is important. Your doctor will be able to identify the type of stone, which helps clarify the cause. The different types of kidney stones include:

• Calcium Stones — These are the most common type and are usually made of calcium oxalate or calcium phosphate. They form when there's too much calcium in the urine or when the urine is too concentrated.
• Uric Acid Stones —These form when there's too much uric acid in the urine, often due to dehydration or a diet high in purines (found in red meats and shellfish).
• Struvite Stones — These are usually associated with urinary tract infections and are made up of magnesium, ammonium, and phosphate.
• Cystine Stones — These are rare and are caused by a hereditary disorder that leads to too much cystine in the urine.

Traditional Diagnostics and Treatment of Kidney Stones

Traditionally, kidney stones are diagnosed using imaging techniques such as X-rays, CT scans, or ultrasounds. This helps doctors determine the characteristics of the stone so that the appropriate treatment method can be chosen. Treatment will vary based on the size, location, and number of stones present, along with your preference (if the stones are small). Some of the most common treatments for kidney stones in the past include the following:

Medications and Pain Relievers

For smaller stones that are likely to pass on their own, doctors may recommend medications to manage pain and help the kidney stone pass more easily. Alpha-blockers, for example, can relax the muscles in the ureter, facilitating the passage of the stone. Alpha-blockers can be particularly helpful for stones in the lower part of the urinary tract or the ureter, where the passage is narrower.

For mild to moderate pain, over-the-counter medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen, are often recommended. These drugs help reduce inflammation and relieve pain, making them a good option when experiencing kidney stone pain. They also help alleviate any swelling or irritation caused by the stone as it moves through the ureter.

For more severe pain, your doctor may prescribe a stronger medication to help manage discomfort. However, since prescription pain medications like opioids and narcotics can be habit-forming, it's important only to use them when absolutely necessary and for short periods.

Ureteroscopy

Traditionally, large urinary stones that cannot be passed naturally have been treated using a ureteroscopy procedure. It's a minimally invasive surgical procedure used to examine and treat conditions affecting the ureters and kidneys, including kidney stones. During the procedure, a thin, flexible tube called a ureteroscope is inserted through the urethra and bladder to reach the ureter or kidney. The ureteroscope allows the doctor to inspect the urinary tract and, if necessary, remove or break up kidney stones.

Laser Lithotripsy

Laser lithotripsy is a procedure to break kidney stones or stones in the urinary tract into smaller, more easily passable fragments. During the procedure, a ureteroscope is inserted through the urethra and bladder to reach the location of the stone. A laser fiber is then passed through the ureteroscope and aimed at the stone. The laser energy fragments the stone into smaller pieces, which can be more easily removed or passed naturally through the urinary tract. Laser lithotripsy is often preferred for treating larger or more complicated stones and is considered a minimally invasive technique.

A few variations of lithotripsy can target larger stones, such as electrohydraulic lithotripsy (EHL) and extracorporeal shockwave lithotripsy (ESWL). Both work on improving kidney stones by fragmentation, but the waves used differ (i.e., shock and pressure waves, respectively).

Percutaneous Nephrolithotomy (PCNL)

Percutaneous nephrolithotomy (PCNL) is an effective surgical procedure used to remove large or complex kidney stones that cannot be treated with less invasive methods like ureteroscopy or extracorporeal shockwave lithotripsy (ESWL). PCNL is typically recommended for kidney stones larger than 2 cm in size or stones located in challenging areas of the kidney, such as the renal pelvis or calyces, which are difficult to access using standard techniques. Some doctors may also recommend surgery to remove ureteral stones that are stuck or have not gotten smaller with other treatment methods.

During a PCNL, an individual is placed under general anesthesia to ensure comfort and immobility during the surgery. A small incision, usually about 1 cm in length, is made in the patient's back, just below the ribs, to provide access to the kidney. Through this incision, a thin tube (called a nephroscope) is inserted into the kidney. The surgeon then creates a direct pathway to the stone by dilating the tract to allow larger instruments to be passed through.

Once access to the stone is obtained, the surgeon uses specialized tools to break it into smaller fragments. Depending on the stone's size and hardness, this can be done using ultrasound, laser, or mechanical devices. The fragments are then carefully removed through the nephroscope. In some cases, the surgeon may need to perform multiple passes to remove all the stone pieces, especially if the stone is very large or has multiple components.

New Techniques and Technologies for Kidney Stone Treatment

New advancements in urology are always sought after, as they offer patients and doctors a more efficient way to treat common conditions. While several effective treatments are currently used for urinary stones, there's still room for growth. A few recent advancements have been made in this field, and some of the most promising new technologies include the following:

Suction-Assisted Ureteroscopic Kidney Stone Evacuation

This is an outpatient procedure that can be performed without making surgical incisions previously required with percutaneous stone surgery. It's performed when kidney stones are in the ureter or kidney and is a variation of traditional ureteroscopy. To begin, the patient is given either general or regional anesthesia for comfort. Then, a ureteroscope is inserted through the urethra and bladder. This allows urologists and doctors to locate the kidney stone in the urinary tract system.

In a traditional ureteroscopy, a laser or forceps is used to break down and remove kidney stones. This procedure starts the same way but adds suction to help remove the broken-down elements of a kidney stone. The suction device is connected to the ureteroscope, allowing the physician to effectively remove stone debris and smaller fragments while minimizing the risk of leaving remnants behind.

This marks several innovations in kidney stone removal, allowing for an efficient, all-in-one procedure that minimizes pain and discomfort. Following the removal, a ureteral stent may be placed in the ureter to help with healing.

Ultrasound Technology Break Wave™ Lithotripsy (BWL)

Recent clinical trials using the latest technologies in lithotripsy have shown promising results for kidney stone treatment and removal. Unlike extracorporeal shockwave lithotripsy, which generally requires anesthesia, BWL uses low-pressure ultrasound waves without anesthesia. These low-pressure waves help target and fragment stones so they're easier to pass. Plus, the equipment used is much smaller and more easily applied than that required in other types of lithotripsy.

In trials, 88% of kidney stone patients had promising results from Break Wave™ lithotripsy. Most patients were able to pass the remaining stone fragments without any additional help, and on a follow-up scan, 49% were completely stone-free.

While kidney stones are common, that doesn't mean they're normal. Kidney stone clearance can be quite painful, and traditional treatments may not be able to eradicate large stones completely. Although there are plenty of promising new technologies in urology, it's still important to talk to your doctor and find out the best option for you. To help address any underlying urologic conditions, Byram Healthcare offers a wide selection of high-quality urologic supplies that can be discreetly delivered to your door. For more information, contact one of our representatives today.