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Advances in kidney-stone treatment now featured at JRMC

Dr. Robert Bates, urologist, in the operating room of Jamestown Regional medical Center. The new urology department now makes it possible to perform kidney stone treatment using endoscopic and lithotripsy. SUBMITTED

Jamestown Regional Medical Center is now treating patients who have kidney stones, a leading health issue with the new urology department, with non-surgical methods.

“(Kidney stone treatment) probably represents 25 to 30 percent of a general urology practice,” said Dr. Robert Bates, head of the urology department that opened in November.

A kidney stone forms when high levels of substances not normally present in the urine accumulate, according to the National Institute of Diabetes and Digestive and Kidney Diseases. A stone travels down the urinary tract and passes naturally or it may stay in the kidney and grow until it can block the flow of urine, causing severe pain or bleeding.

Around 13 percent of the general population will form kidney stones, Bates said.

JRMC now has endoscopic instruments that look into the kidney by using a telescopic tube. A laser fiber is used to break up the stone into dust and small pieces and pull them out.

A lithotripsy mobile unit is available to JRMC as an alternative method, mostly for patients who do not need immediate care and can schedule an appointment, Bates said. It uses shock waves generated outside of the body that are focused on the stone, like the sun through a magnifying glass, he said.

“The shockwave energy is delivered to the stone at like 60 shocks per minute,” Bates said. “That breaks up the stone into small pieces and the patient then passes those pieces.”

There are a few complex pediatric cases or complex cancer operations that would be referred to other hospitals, Bates said. But with the technology, JRMC can handle 99 percent of stone cases that occur in the 45-mile service area around Jamestown, he said.

“This whole field just continues to improve over time and makes it easier and easier on patients,” Bates said.

Treating kidney stones

For the first decade of his 30-year urology practice, Bates said removing kidney stones required a surgical incision and post-operational healing with up to a week in the hospital and several weeks of recovery.

More noninvasive technology developed in the 1980s has gradually improved to the point where surgery is the exception, he said. Kidney-stone treatment has transitioned to minimal or noninvasive procedures that do not require hospitalization, and normal activity can usually be resumed in a few days.

“I haven’t done an open-stone case to make an incision in well over five years,” Bates said.

More than half a million people visit emergency rooms for kidney-stone problems annually, according to the foundation.

Smaller kidney stones can be treated with medication so they pass naturally, but most people don’t know they have stones until they move and cause an obstruction, he said. Acute ureteral-colic kidney-stone pain can move from the side to the groin, he said.

“For most patients with stones it comes on like a lightning bolt and people who have had them before recognize it immediately,” Bates said. “The emergency room is almost always the point that referrals come from.”

A recent case involved a young woman driving from Bismarck to the Twin Cities for school, he said. She recognized a repeat kidney-stone attack while going through Jamestown and stopped at the JRMC emergency room. She was admitted to the hospital and after treatment, she was cleared to leave JRMC the next afternoon.

Someone who has had a kidney stone and does nothing to reduce his or her risk will then have a 50 percent chance of forming another within three years, Bates said. Treatment is the first step, but an evaluation follows to help patients manage their health to prevent more stones in the future, he said.

Genetics are unavoidable as 40 percent of people with stones have a first-degree family member who also had a stone, he said. But drinking more water and a heart-healthy diet are beneficial in reducing risk, he said.

“The most significant factor over the past 20 years is obesity,” he said. “There is a marked increase in the number of stones that tracks the average weight of the population.”