Cover Page

Urinary Stones

Medical and Surgical Management

Edited by

Michael Grasso, MD

Professor and Vice Chairman

Department of Urology

New York Medical College

Valhalla, NY, USA

David S. Goldfarb, MD, FASN

Clinical Chief, Nephrology Division

NYU Langone Medical Center;

Professor of Medicine and Physiology

New York University School of Medicine

New York, NY, USA

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List of Contributors

Sachin Abrol, MS
Resident in Urology
Muljibhai Patel Urological Hospital
Nadiad, Gujarat, India

Ahmed Alasker, MD, FRCS(C)
Endourology, Robotic and Laparoscopy Fellow
Albert Einstein College of Medicine
Montefiore Medical Center
Bronx, NY, USA

Bobby Alexander, MD
Fellow
Division of Endourology
Lenox Hill Hospital
New York, NY, USA

John R. Asplin, MD, FASN
Medical Director, Litholink Corporation;
Clinical Associate
Department of Medicine
University of Chicago
Chicago, IL, USA

Demetrius H. Bagley, MD, FACS
The Nathan Lewis Hatfield Professor of Urology
Professor of Radiology
Department of Urology
Thomas Jefferson University
Philadelphia, PA, USA

Michael S. Borofsky, MD
Chief Resident in Urology
New York University Langone Medical Center
New York, NY, USA

Kai-wen Chuan, MD
Chief Resident
The Arthur Smith Institute for Urology
North Shore-Long Island Jewish Health System
New Hyde Park, NY, USA

Michael J. Conlin, MD
Associate Professor
Portland VA Medical Center;
Department of Urology
Oregon Health & Science University/Portland VA Medical Center
Portland, OR, USA

Angela M. Cottrell, FRCS (Urol), MBBS, BSc, Dip Clin Ed
Specialist Registrar, Urology
Derriford Hospital
Plymouth Hospitals NHS Trust
Plymouth, UK

Michel Daudon, PhD
Chief of the Stone Laboratory
Department of Clinical Physiology
APHP, Tenon Hospital
Paris, France

Michael Degen, MD
Fellow
Division of Endourology and Minimally Invasive Urology
Westchester Medical Center;
Department of Urology
New York Medical College Valhalla, NY, USA

Mahesh R. Desai, MS, FRCS
Medical Director
Muljibhai Patel Urological Hospital
Nadiad, Gujarat, India

Sameer M. Deshmukh, MD
Resident in Urology
Department of Urologic Sciences
Stone Centre at Vancouver General Hospital
Vancouver, BC, Canada

Andrew J. Dickinson, MD, FRCSUrol, FRCSEd
Consultant Urologist
Derriford Hospital
Plymouth Hospitals NHS Trust
Plymouth, UK

Christopher M. Dixon, MD
Associate
Division of Endourology
Lenox Hill Hospital
New York, NY, USA

Brian D. Duty, MD
Assistant Professor
Department of Urology
Oregon Health & Science University/Portland
VA Medical Center
Portland, OR, USA

Vidar O. Edvardsson, MD
Director of Pediatric Nephrology
Children's Medical Center
Landspitali – The National University Hospital of Iceland;
Faculty of Medicine, School of Health Sciences
University of Iceland
Reykjavik, Iceland

Brian H. Eisner, MD
Co-Director of Kidney Stone Program
Department of Urology
Massachusetts General Hospital
Harvard Medical School
Boston, MA, USA

Majid Eshghi, MD, FACS
Division of Endourology and Minimally Invasive Urology
Westchester Medical Center;
Department of UrologyNew York Medical College
Valhalla, NY, USA

Andrew I. Fishman, MD
Assistant Professor of Urology
Department of Urology
New York Medical College
Valhalla, NY, USA

Israel Franco, MD
Director of Pediatric Urology
Maria Fareri Children’s Hospital
Professor of Urology
New York Medical College
Valhalla, NY, USA

Sean Fullerton, MD
Assistant Professor
Department of Urology
New York Medical College
Valhalla, NY, USA

Arvind P. Ganpule, MS, DNB
Vice-Chairman
Department of Urology
Muljibhai Patel Urological Hospital
Nadiad, Gujarat, India

Reza Ghavamian, MD
Professor of Clinical Urology
Chairman of Urology
Albert Einstein College of Medicine
Montefiore Medical Center
Bronx, NY, USA

Jordan Gitlin, MD
Attending Pediatric Urologist
Cohen Children’s Medical Center of New York;
The Arthur Smith Institute for Urology
North Shore-Long Island Jewish Health System
New Hyde Park, NY, USA

David S. Goldfarb, MD, FASN
Clinical Chief, Nephrology Division
NYU Langone Medical Center;
Professor of Medicine and Physiology
New York University School of Medicine
New York, NY, USA

Michael Grasso, MD
Professor and Vice Chairman
Department of Urology
New York Medical College
Valhalla, NY, USA

Kelly A. Healy, MD
Assistant Professor
Department of Urology
Thomas Jefferson University
Philadelphia, PA, USA

Nicole Hindman, MD
Assistant Professor of Radiology
Department of Radiology
New York University Lagone Medical Center
New York, NY, USA

David Hoenig, MD
Associate Professor of Clinical Urology
Albert Einstein College of Medicine
Montefiore Medical Center
Bronx, NY, USA

Paul Jungers, MD
Emeritus Professor of Nephrology
Paris V University;
APHP, Department of Nephrology
Necker Hospital
Paris, France

Francis X. Keeley Jr, MD, FRCS(Urol)
Consultant Urologist
Bristol Urological Institute
Bristol, UK

Nir Kleinmann, MD
Attending Urologist
Department of Urology
Sheba Medical Center
Tel Hashomer, Israel

Abhishek Laddha, MS
Resident in Urology
Muljibhai Patel Urological Hospital
Nadiad, Gujarat, India

Dirk Lange, BSc, PhD
Assistant Professor
Department of Urologic Sciences
University of British Columbia
Vancouver, BC, Canada

Julien Letendre, MD, FRCSC
Fellow of Endourology
Department of Urology
Tenon Hospital, Assistance Publique – Hôpitaux de Paris
Pierre et Marie Curie University
Paris, France

John C. Lieske, MD
Professor of Medicine
Division of Nephrology and Hypertension
Mayo Clinic
Rochester, MN, USA

James E. Lingeman, MD
Professor
Department of Urology
Indiana University School of Medicine
Indianapolis, IN, USA

Naim M. Maalouf, MD
Assistant Professor of Medicine
Department of Internal Medicine and Charles and
Jane Pak Center for Mineral Metabolism and Clinical Research
University of Texas Southwestern Medical Center
Dallas, TX, USA

Sunil Mathur, MD, FRCS (Urol)
Consultant Urologist
Great Western Hospital
Swindon, UK

Lesli Nicolay, MD
Assistant Professor
Division of Pediatric Urology
Loma Linda University Medical Center
Loma Linda, CA, USA

Runolfur Palsson, MD
Chief, Division of Nephrology
Landspitali – The National University Hospital of Iceland;
Associate Professor of Medicine
Faculty of Medicine, School of Health Sciences
University of Iceland
Reykjavik, Iceland

Jessica E. Paonessa, MD
Endourology Fellow
Department of Urology
Indiana University School of Medicine
Indianapolis, IN, USA

Sherry S. Ross, MD
Director of Pediatric Urology Stone Clinic
Department of Surgery
Division of Urology
Section of Pediatric Urology
Duke University Medical Center
Durham, NC, USA

Ojas Shah, MD
Associate Professor, Director of Endourology and Stone Disease
New York University Langone Medical Center
New York, NY, USA

Shonni J. Silverberg, MD
Professor of Medicine
Columbia University
College of Physicians and Surgeons
New York, NY, USA

Olivier Traxer, MD, PhD
Professor of Urology
Department of Urology
Tenon Hospital, Assistance Publique – Hôpitaux de Paris
Pierre et Marie Curie University
Paris, France

Robert J. Unwin, PhD, FRCP, FSB, CBiol
Professor of Nephrology and Physiology
Head of Centre and Research Department of Internal Medicine UCL
UCL Centre for Nephrology
University College London Medical School
London, UK

Marcella Donovan Walker, MD, MS
Assistant Professor of Medicine
Columbia University
College of Physicians and Surgeons
New York, NY, USA

Stephen B. Walsh, PhD, MRCP
Clinical Senior Lecturer in Experimental
Medicine/Honorary Consultant Nephrologist
UCL Centre for Nephrology
University College London Medical School
London, UK

Oliver M. Wrong, DM, FRCP
Former Emeritus Professor of Medicine
UCL Centre for Nephrology
University College London Medical School
London, UK

Preface

The natural history of urinary calculi reflects a spectrum of clinical presentations, some with a benign course but many others with the potential for severe and often catastrophic outcomes. Urinary calculi frequently are the sequelae of major underlying metabolic disorders, which if left untreated are regularly associated with recurrent stone events with the ultimate potential for renal parenchymal loss. It is the co-ordination of both surgical intervention to remove obstructing concretions and improve drainage, and the simultaneous application of novel medical therapies employed to alter the underlying hypermetabolic disorder that ultimately changes the natural history of this morbid ailment.

As Editors of this book we represent varied perspectives on stone management, with 18 years of daily collaboration treating the most complex hypermetabolic stone formers. We created the first multimodality stone center in New York and continue to regularly care for patients together. This collaborative spirit of endourology and nephrology has led to a broad spectrum of innovative therapies, many of which will be presented in this text. Our chapter authors reflect international thought leaders in urinary stone management, each offering unique insight into patient evaluation and specific therapies.

We, the editors and authors, are fundamentally committed to improving patient care by developing and employing new treatments, and by encouraging and nurturing the next generation of providers through fellowship training and scholarly efforts. We have always believed and taught that nephrologists need to more fully understand the surgical management of stone disease in order to counsel their patients, and urologists who understand metabolic stone disorders will offer their patients a higher and more attractive level of service.

This text is designed to be a resource for the practitioner when confronted with a challenging clinical presentation. There is an orderly division of chapters: patient assessment, imaging, surgical interventions, and medical therapies. The underlying theme, however, is collaboration of implementation – mixing and matching therapies as required by the presented clinical variables. For example, a patient who presents with urinary tract obstruction and with urosepsis during systemic chemotherapy for acute leukemia requires input from many areas to craft a comprehensive treatment plan. The emergency renal drainage algorithm in the surgical section is promptly applied. Varied interventions as necessary are employed next to clear the stone burden, with subsequent additional medical therapies to treat the underlying hyperuricosuria and minimize future episodes.

It is our intention to offer a user-friendly resource to the clinician. Various treatments are presented with regard to indications, technical nuances, complications, continuity of care, and preventive measures. It is our hope that through efforts like this text, comprehensive collaborative treatment centers will grow, employing many of the tenets described herein.

Michael Grasso

David S. Goldfarb

PART 1
Types of Urinary Stones and Their Medical Management