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]

@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.

[running_coach]

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.

[running_coach]

@runner pat

Next on Mythbusters.

"Jamie want little tiny boom. "

“Am I missing… a kidney?”

“Blast danger! Clear the urea!”

[Una_Persson]

@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]

@runner pat

“Blast danger! Clear the urea!”

I am never going to be able to hear “Fire in the hole!” without smirking EVER AGAIN. :eek:

[campp]

@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]

@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]

@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]

@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]

@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]

@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]

@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.