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Welcome to the Why Urology podcast with Dr. Todd Brandt.

This podcast is my personal attempt to teach you about your genito-urinary tract, what can go wrong, and how your urologist may just become your superhero.

The name of the podcast comes from my ongoing need to answer the question that I get so often from patients, friends, and family, “Why Urology? Why did you choose to become a urologist?”

Sep 2, 2017

Odds are that 1 in 10 of us will one day get a kidney stone within our lifetime. Your chances of having a kidney stone increase if you are white, middle-aged, obese, have previously had a kidney stone, have a family history of stones, or live in a hot climate. A kidney stone is a jagged crystal that grows from the minerals and salts in your urine. Kidney stones form when the mineral and salts in urine are too concentrated. I also give you 5 simple things you can do with your diet that will help to prevent kidney stones:

  1. Drink more water or lemonade
  2. Moderate your salt intake
  3. Get an adequate amount of calcium in your diet
  4. Limit your consumption of foods containing a high concentration of a mineral called oxalate (examples include nut, leafy green vegetables, and chocolate)
  5. Moderate your consumption of animal protein.

A kidney stone forms in the drainage system, the collecting system, of your kidneys. A kidney stone can be as small as a grain of sand, or several inches across. There is really no way to dissolve a kidney stone. A stone, once it is made, must either pass spontaneously through the drainage system or, if it cannot pass, must be removed or broken up in some way to allow it to pass. For many, many years the removal of kidney stones required an incision. The surgical option goes back to antiquity. In his famous oath, Hippocrates, an ancient physician from about 400 B.C. who has been called the “Father of Modern Medicine” because of the advances he brought to the practice of medicine, vowed to “not cut for stone,” instead leaving that to those who were “practiced” in the art. And for many years surgeons did have to “cut for stone.” In the early 1980s surgical techniques changed dramatically.  In episode 30 I talked about the invention and development of the shock wave lithotripter that can pass shock waves through a patient’s body to break up a kidney stone without making an incision. In today’s episode, I want to discuss the procedure we call a percutaneous nephrolithotomy (PCNL). Along with the ESWL and the ureteroscopy the PCNL is one of the three procedures that allow urologists today to remove 99-plus percent of all kidney stones without making a large incision. The article that proved its effectiveness was published in the Journal of Urology, now celebrating its 100th year of publication and is included along in the special Anniversary edition of the journal which reprinted some of the most impactful articles of the last 100 years. The original series reported on the PCNL was in 1981 out of the department of urology in Mainz, Germany. I give a synopsis of their results during this episode. The percutaneous nephrolithotomy is most often the best treatment for the largest or most complex stones. A PCNL is typically done under general anesthesia and requires at least an overnight hospitalization. In my practice, we most often perform the PCNL in one surgical episode, gaining access to the kidney alongside an interventional radiologist who helps us dilate the track and get access to the appropriate calyx within the collecting system. Once in the collecting system the stone can be visualized through a scope and a form of lithotripsy can be performed to break up the stone. Once the stones are broken into small enough pieces the pieces can be removed through the tract that we made. Because our access into the kidney is through a direct, and dilated tract we get excellent visualization through the high definition cameras we use. Most often a urologist is able to remove all of the stone within the kidney during just one surgery. Flexible and rigid scopes are used during this procedure to access the entire collecting system to make sure that the kidney is stone free. Stone free rates­–leaving the operating room with no stones left in the kidney we operated on–are very high in this procedure. After the stones are removed some form of drain or tube is left in to allow the kidney to drain and heal after the procedure. Either a ureteral stent which is on the inside of the body or some sort percutaneous tube called a nephrostomy tube is left in place. These tubes are not permanent and are removed typically within days after the procedure. Fortunately, the complication rates are low outside of a small bleeding risk that your body can control and the risk of infection which can be controlled with antibiotics. Other more serious but much less frequent complications for this procedure exist but overall this is a very safe and very good procedure for those patients who require it. As I said before, the original series reported on the PCNL was published in the Journal of Urology in 1981. Reviewing that article shows us how far we have advanced in this technique. You can find the article at www.JU100.org