At the International Kidney Stone Institute, our goal is nothing less than the cure.

What is Best For Me?

If a kidney stone problem is uncomplicated, any intervention (Extracorporeal Shock Wave Lithotripsy, Ureteroscopy, Percutaneous nephrolithotomy) will be successful.  However, if the stone problem is complex, Percutaneous nephrolithotomy (PNL) is the best treatment.  Complex stone problems include large stones (>2.0 cm), stones known to be resistant to Extracorporeal Shock Wave Lithotripsy (ESWL), such as cystine and brushite, and stones occurring in kidneys with abnormal anatomy, such as pelvic kidney or horseshoe kidney.  Finally,  PNL is useful in cases where ESWL or Ureteroscopy have failed to adequately treat the existing stone.

Clinicians at the International Kidney Stone Institute believe that an individual’s stone burden requires a tailored approach specific to each patient’s unique circumstances.  Although in theory ESWL, URS and PNL can be used for a wide variety of kidney stone problems, in reality, each approach has definite advantages and disadvantages.  For example, ESWL tends to work best for smaller stones in the kidney and is much less effective for larger kidney stones or stones in the ureter.  URS is generally preferred for stones in the ureter and smaller stones in the kidney.  Large stones are difficult to treat successfully with a single treatment session of ESWL or URS.  For this reason, larger stones are often best and most completely treated with PNL.

IKSI’s recommended approach is to treat an individual patient’s stone problem in the most efficient manner that will remove the stones as completely as possible with the fewest number of treatments and the least amount of morbidity or complications.  Further, an effort is made to minimize the use of ureteral stenting due to the discomfort stents cause.  For example, PNL if often preferred for treating patient with larger stones (>2.0 cm), because the actual discomfort associated with this slightly more invasive procedure is more than offset by the discomfort avoided by not needing ureteral stenting necessary with ESWL.  In addition, the need for multiple sessions of ESWL and a prolonged treatment course are eliminated by the more efficient PNL procedure.

If you would like to have IKSI review your case, please send your information to csprunger@iuhealth.org.