Treating kidney stones with high explosives

[sweeteviljesus]

Inspired by today's column:

Years ago, I saw a show where a urologist was surgically treating kidney stones using a catheter tipped with a minute amount of PETN or something similar, and using a scope, placed it next to an offending stone and blew it to smithereens which one assumes were small enough to pass without discomfort. Whatever became of this therapy?

Thanks,
Rob

Bring on the "need answer fast" jokes.

[TriPolar]

Assuming such a thing were ever real, it would be surpassed by the use of extracorporeal shock wave lithotripsy to break up stones.

[Scacarius]

"Kidney stones of half a centimeter or less pass spontaneously about 70 percent of the time, and stones up to one centimeter have nearly a 50 percent chance of passing without treatment."

That's got to be millimeters, right?

[Little Nemo]

Originally Posted by Scacarius

"Kidney stones of half a centimeter or less pass spontaneously about 70 percent of the time, and stones up to one centimeter have nearly a 50 percent chance of passing without treatment."

That's got to be millimeters, right?

I know if I passed a one centimeter kidney stone, I'd want extensive treatment afterwards.

[runner pat]

Next on Mythbusters.

"Jamie want little tiny boom. "

"Am I missing... a kidney?"

[njtt]

Extracorporeal shock wave lithotripsy sounds really cool!

[TriPolar]

Sounds way better than passing a 1cm stone.

[runner pat]

Originally Posted by runner pat

Next on Mythbusters.

"Jamie want little tiny boom. "

"Am I missing... a kidney?"

"Blast danger! Clear the urea!"

[Una Persson]

Originally Posted by Scacarius

"Kidney stones of half a centimeter or less pass spontaneously about 70 percent of the time, and stones up to one centimeter have nearly a 50 percent chance of passing without treatment."

That's got to be millimeters, right?

No. See:

Preminger, Glenn M. et al. “2007 Guideline for the Management of Ureteral Calculi” European urology 52 (2007): 1610-1631.

For stones <=5 mm, meta-analysis of five patient groups (224 patients) yielded an estimate that 68% would pass spontaneously (95% CI: 46% to 85%). For stones >5 mm and <=10 mm, analysis of three groups (104 patients) yielded an estimate that 47% would pass spontaneously (95% CI: 36% to 59%).

and

Gettman, Matthew T. and Segura, Jospeh W. “Management of ureteric stones: issues and controversies” BJU International 95 (2005): 85-93.

Stone size and initial stone location influence the likelihood of spontaneous stone passage and guide treatment recommendations. Segura et al. reported spontaneous passage in 29–98% of stones of <5 mm diameter above the iliac vessels, and 71–98% of stones of < 5 mm diameter below the iliac vessels. For stones of 5–10 mm diameter, spontaneous passage occurred in 10–53% of proximal calculi and 25–53% of distal calculi.

In a multivariate analysis of risk factors associated with spontaneous ureteric stone passage, Miller and Kane found that smaller, more distal stones on the right side were more likely to spontaneously pass and require fewer surgical interventions. In a recent report by Coll et al. spontaneous ureteric stone passage rates, regardless of size, were 48%, 60%, 75% and 79% for stones in the proximal, middle and distal ureter or at the vesico-ureteric junction, respectively.

Una
For the Straight Dope

[gnoitall]

Originally Posted by runner pat

"Blast danger! Clear the urea!"

I am never going to be able to hear "Fire in the hole!" without smirking EVER AGAIN.

[campp]

Originally Posted by sweeteviljesus

Inspired by today's column:

Years ago, I saw a show where a urologist was surgically treating kidney stones using a catheter tipped with a minute amount of PETN or something similar, and using a scope, placed it next to an offending stone and blew it to smithereens which one assumes were small enough to pass without discomfort. Whatever became of this therapy?

Thanks,
Rob

Bring on the "need answer fast" jokes.

Laser lithotripsy does exactly this. Very effective therapy.

[aruvqan]

Either way, 1 cm stone or little boom ...

OUCH!

[Scacarius]

Originally Posted by Una Persson

No. See:

Preminger, Glenn M. et al. “2007 Guideline for the Management of Ureteral Calculi” European urology 52 (2007): 1610-1631.



and

Gettman, Matthew T. and Segura, Jospeh W. “Management of ureteric stones: issues and controversies” BJU International 95 (2005): 85-93.



Una
For the Straight Dope

So, yes, right? All of those references are in millimeters. I've passed a kidney stone and the idea of a 1 cm stone is pretty terrifying.

[gazpacho]

Originally Posted by Scacarius

So, yes, right? All of those references are in millimeters. I've passed a kidney stone and the idea of a 1 cm stone is pretty terrifying.

You do realize that 10mm is 1cm right? The cited articles talk about stones size from 5 mm to 10 mm. The SD article talks about .5cm to 1cm. Those are the same lengths.

[Una Persson]

Originally Posted by gazpacho

You do realize that 10mm is 1cm right? The cited articles talk about stones size from 5 mm to 10 mm. The SD article talks about .5cm to 1cm. Those are the same lengths.

Exactly.

I've passed a kidney stone which was about 3x5mm, and it was...horrible.

[TriPolar]

Originally Posted by gazpacho

You do realize that 10mm is 1cm right? The cited articles talk about stones size from 5 mm to 10 mm. The SD article talks about .5cm to 1cm. Those are the same lengths.

It ain't the length that distresses me, it's the width. I'd rather use the explosive than pass a .00001 kilometer stone.

[Scacarius]

Originally Posted by gazpacho

You do realize that 10mm is 1cm right? The cited articles talk about stones size from 5 mm to 10 mm. The SD article talks about .5cm to 1cm. Those are the same lengths.

Well....

Never mind, then.

[donkeyoatey]

I have passed two stones that were about 1x1cm and about .3 to .4 thick. This is approximate,of course because they were very irregular in shape. Also passed about 15 more anywhere from 1/4 to 3/4 that size. And what you may think of as passing them is relatively painless, when they rip their way through the kidney the pain is incredible.And, hey,Linus Pauling, you bastard, I stopped taking mega-doses of vitamin C when I found out what was causing them!

[wadewood]

Passing stones does not cause pain. Kidney stones cause pain when they can't be passed. When stuck they block the flow of urine which causes backpressure on the kidneys, which is very painful.

[ftg]

Originally Posted by wadewood

Passing stones does not cause pain. Kidney stones cause pain when they can't be passed. When stuck they block the flow of urine which causes backpressure on the kidneys, which is very painful.

False. The main pain is usually caused by the body trying to force the stone along. Plus they do sometimes scrape things and help cause an infection, which adds to the fun.

[DSYoungEsq]

Originally Posted by ftg

False. The main pain is usually caused by the body trying to force the stone along. Plus they do sometimes scrape things and help cause an infection, which adds to the fun.

Your link does not support your claim, exactly. And while it may be the case that there is pain from the process of passing the irregularly shaped (and often sharply pointed in places) object, the vast majority of the pain is located in the renal area regardless of where the stone is blocked, and caused in large part by either the damage done by the stone upon exiting, or the backup of the flow of urine in the kidneys.

I've passed 10 stones. The last stone managed to get lodged in the ureter somewhere between the kidney and the bladder, quite low down (they weren't able to use lithotripsy it was so low down). It stayed there, causing intermittent symptoms for several months, before finally acting up for good over the course of several days, forcing the urologist to take his laser to it. In each case of symptoms, the symptoms were located primarily in the location of the affected kidney; some mild, secondary discomfort at the site of the stone rarely was sufficient to do much more than have me take an ibuprofen. For those who don't know: ibuprofen doesn't do diddly with kidney stone renal colic.

[ftg]

Originally Posted by DSYoungEsq

I've passed 10 stones. The last stone managed to get lodged in the ureter somewhere between the kidney and the bladder, quite low down (they weren't able to use lithotripsy it was so low down). It stayed there, causing intermittent symptoms for several months, before finally acting up for good over the course of several days, forcing the urologist to take his laser to it. In each case of symptoms, the symptoms were located primarily in the location of the affected kidney; some mild, secondary discomfort at the site of the stone rarely was sufficient to do much more than have me take an ibuprofen. For those who don't know: ibuprofen doesn't do diddly with kidney stone renal colic.

If you go months with a lodged stone, you don't have urine backing up into your kidney to any significant degree. Also, if it's not moving, it's not making new scrapes. Perhaps just continuing to irritate one spot.

Also note that the source of the pain and where you feel it are two different things inside the body. People can feel pain in their shoulder from a bad appendix, for example.

I just gave one cite. Here's another:

"renal colic:
sharp, severe pain in the lower back over the kidney, radiating forward into the groin. Renal colic usually accompanies forcible dilation of a ureter, followed by spasm as a stone is lodged or passed through it."
Mosby's Medical Dictionary, 8th edition, 2009.

Most people don't get any urine backup. The famous "more painful than having a baby" symptom is your body trying to push the stone along in most cases.

[DiamondNinja]

I've passed three stones, all around 4mm. I've also had a ureteroscopy for a 1 cm x .9 mm stone that got stuck at the junction of the bladder three days after delivering my sixth baby in the front seat of my car. I also had lithotripsy three months later for two more 1cm + stones.

I felt pain in my back and in the ureter. As a matter of fact, I felt the twinges and pinches in my ureter before I felt any other pain. Once the back pain set in, especially with the lodged stone, I was in pure agony. Never during any of my (luckily) shirt lahore did I scream or wish to be knocked out. I was begging for anything with these little suckers. I still have several stones, and trust me: I delivered all six children with no pain meds...I'd do that all over again, back-to-back, before I'd pass any large stone. Even the 4mm stone felt like I was being ripped from the inside out.

I need to find out why I'm forming these...my last analysis was inconclusive. Time for another evaluation.

[Krokodil]

I had one that was broken up with sound waves. No catheter, quick (2 days) recovery. The follow-up involved catheters, though...

[DiamondNinja]

Originally Posted by Krokodil

I had one that was broken up with sound waves. No catheter, quick (2 days) recovery. The follow-up involved catheters, though...

Oh, I had a stent for a week after the ureteroscopy, nothing after the lithotripsy.

[XOKat]

Mahalo and aloha, dear Cecil,

Just finished digesting your latest article re kidney stones. It is the most accurate, informative, and concise mini paper I have ever read. You even explain how one can do the wrong thing and cause serious problems relating to ph imbalance. I inadvertently did just that, causing a staghorn kidney stone condition which I have battled with for the last 6 years or so. However, I am doing fine with my own methods of prevention/treatment. Without any medical intervention, I successfully passed a 1.5 cm plus a 2.0 cm stone (Yes, cm, not mm) with minimal discomfort. I fear urologists because, in my experience, they either do not know how or are unwilling to bother informing patients how to practive preventative measures and/or effectively treat UTIs. My experience is that all they reaaly want to do is operate. And attempting to smash kidney stones may be considered less invasive, but it can still cause kidney damage in addition to one possibly suffering later from diabetes or high blood pressure. This practice consists of shooting on target thousands of times inside one's kidney/s. I pass!

Mahalo, again. What was difficult or complicated for me to explain to concerned friends why their general advice is not appropriate for me, specificially because I already learned the hard way, I now have your article to share. It will either be much photocopied or I shall pick up numerous copies of The Weekly where you appeared. I trust you even more now, The Straight Dope.

Aloha,
KatXO

[Irishman]

Originally Posted by XOKat

Without any medical intervention, I successfully passed a 1.5 cm plus a 2.0 cm stone (Yes, cm, not mm) with minimal discomfort.

If you successfully passed with minimal discomfort, then you did not require medical intervention.

I'm not sure I believe you passed a 2 cm stone with minimal discomfort, though.

I fear urologists because, in my experience, they either do not know how or are unwilling to bother informing patients how to practive preventative measures and/or effectively treat UTIs.

My father not only had the kidney stone removed (it was lodged), he was given dietary instructions to reduce the incidence of future stones. Which he mostly follows.

[Michael63129]

A bit late, but blowing up kidney stones with explosives has actually been done (news article from 1981).

TOKYO(AP) - A Japanese researcher said Saturday he has successfully removed large kidney stones from two patients by setting off small explosive charges in their bladders.

[Folacin]

I've had stones twice (that I know of - I'm starting to think that some of my random low back pain is small stones).

The first time the stone apparently passed on its own. The second time, I had a laser removal on the right (I think stuck just short of the bladder), and sonic lithoscopy on the left (in the kidney). I never really felt anything passing the fragments out of the left side (although I had a stent, so that might have affected that), and there were a lot of fragments, and some of them were pretty big.

The point being the actual passing/peeing out bit was painless - but maybe the pain is getting them to the bladder?

[Learjeff]

Originally Posted by DSYoungEsq

For those who don't know: ibuprofen doesn't do diddly with kidney stone renal colic.

Wrong. It's better than morphein (which in my case, didn't do diddly.) The IV form of ibuprofen, and later ibuprofen itself, helped amazingly. Three reasons (1) it's an analgesic (2) it reduces inflammation, and (3, most significantly) suppresses peristalsis. This according to the ER doctor who treated me.

Ibuprofen works wonders for kidney stones. The only thing that worked better was a hot tub, but unfortunately that doesn't last as long.

I had a 1 cm stone, stuck in my kidney at the opening to the ureter. ECL blasted it, after which I enjoyed a week of passing gravel (max 2mm stones). I had previously passed a 2mm stone. No fun. I don't ever want to experience anything like a 5mm stone!

I can't imagine passing a 2cm diameter stone without extreme agony. Perhaps that was 2cm circumference?