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Urologic Care for Kidney Conditions

In kidney care, urologists concentrate on managing and treating conditions that may require invasive intervention (including endoscopy or surgery), especially kidney stones and kidney cancer.   They collaborate with Lourdes’ accomplished nephrologists (kidney specialists), who specialize in kidney diseases that affect kidney function and broad systemic conditions such as cardiovascular disease, diabetes, and hypertension related to the kidney.

Lourdes nephrologists manage services for kidney disease prevention and diagnosis, as well as dialysis and kidney transplantation.   They work closely with Lourdes’ urologists when an acute condition requires intervention through surgery or other direct or minimally invasive treatment.  

Kidney Stones

Kidney stones are common and can occur in anyone, but middle-aged men (especially if they are obese or have a family history of kidney stones) are most at risk.   Usually characteristic pain (in the flank and urinary tract) along with blood in the urine are adequate signs to make the diagnosis, but patients may also undergo radiologic imaging to help confirm the presence of the stone, as well as its location and size.   These tests can include ultrasound, CT imaging or intravenous pyelogram.   Pain during active passing of a stone is often severe; thus, patients usually receive care in the emergency room where I.V. fluids can help the stone to pass and painkillers can help the patient endure the experience.

Learn more about kidney stones and their prevention, diagnosis and treatment, including care from Lourdes knowledgeable nephrologists.

Staying under the care of a primary, family doctor is usually adequate for someone who has passed a stone without complications.   If a stone is stuck or in a size and location that threatens the function of the kidney or flow of urine, the urologist’s care is needed.   (Individuals who have recurrent stones may need the care of a nephrologist to manage medications and dietary adjustments to decrease stone formation.)

Intervention to remove a kidney stone is only necessary if the stone does not pass because it is too large or in a difficult location, or if it is blocking the flow of urine or causing debilitating pain, bleeding or infection.  In these acute or urgent cases, Lourdes urologic specialists can use a number of methods to remove kidney stones:

  • endoscopy. The urologic team can access the stone visually with ureteroscopes, fine, tube-like scopes, and use these instruments to relocate or to disrupt or remove the stones (a process known as ureteropyeloscopy). The scope has its own light source and miniaturized camera to provide a video image of urinary tract.   Introduced up through the urethra, into the bladder and into the ureter (the tube between the bladder and the kidney) under anesthesia, the ureteroscope also permits the team to insert (and later to remove) a ureteral stent to help keep urine flowing when a stone is lodged or moving.   The stent may be left in place while the team uses other means, such as lithotripsy, to dislodge or disrupt the stone.
  • lithotripsy. For cases where the stone cannot be easily and nonsurgical removed or passed otherwise, Lourdes offers extracorporeal shockwave lithotripsy to breakdown the stone so that it can pass easily. Lithotripsy pulverizes stubborn stones to smaller, sometimes granualized size, that can usually be voided painlessly. The procedure involves anesthetizing the area, placing the patient in a bath or against a water cushion and creating shockwaves that pass through the body until they reach and disrupt the stones. Usually, lithotripisy is performed on an outpatient basis and patients recover in just a few days.
  • endoscopic and open surgery. Common decades ago for this condition, surgery can usually be avoided today with the outpatient procedures described above. But when stones are very difficult to remove otherwise–usually because of their size–surgery remains a dependable option. In the past, it always involved a large incision in the side and in the kidney, to allow the general surgeon or urologist to remove the stone with forceps. It also required an inpatient stay, and a considerable period of recovery.   This open form of nephrotomy surgery remains a viable option for the rare patient with a very difficult case; however, most urologic surgeons perform most kidney stone operations today endoscopically, using the nephroscope. Nephroscopic procedures have been a great stride in kidney stone surgery.   This minimally invasive surgical procedure requires only a small incision (typically 6-7 mm.) in the back. Through a similar incision in the kidney itself, the Lourdes urologist reaches the stone with these slender instruments.   With this access, the Lourdes team uses the latest nephroscopic tools to break up or capture the kidney stone.  Typically, the tool that the Lourdes team introduces through the incision in this percutanteous neprhotomy procedure uses laser energy to break up the stone and then suction grasping to help the surgeon remove the stone pieces.
Kidney Cancer

Cancer of the kidney usually originates in the kidney.   A number of factors can increase risk, including environmental exposure, family history, lifestyle and medical conditions.   Symptoms can include blood in the urine; rapid, unexplained weightloss; unexplained back pain; and loss of appetite.   A number of blood, laboratory and urologic tests can confirm the diagnosis.   The team may also use a nephroscopy procedure to gain visual access to the tumor (using a fine endoscope advanced percutaneously to and into the kidney).

As part of the Lourdes cancer team treating patients diagnosed with kidney cancer, Lourdes urologists are responsible for surgical treatment, which is aimed at removing the kidney tumor.   Surgery to remove a cancerous kidney or kidney tumor is called nephrectomy.   In a simple nephrectomy, the urologic surgeon removes only the kidney.   If the team sees any evidence that the cancer is spreading, it may perform a radical nephrectomy to remove not just the kidney but the adrenal gland and tissue around the kidney, including the lymph nodes.   A nephroureterectomy is removal of kidney, the ureter connecting the kidney to the bladder, and protion of the contiguous bladder.

Increasingly though, in cases where the cancer has not spread, the Lourdes team will perform a partial nephrectomy.   In this newer approach to localized kidney cancer, the team removes only the area of the kidney that contains the tumor, and spares the remaining healthy portion of the kidney so it can heal and resume function.   This strategy is also referred to as the nephron-sparing surgery.

In terms of cancer survival, patients who undergo a partial nephrectomy do as well as those who have had the entire kidney removed.   Moreover, recent data supports the conclusion that these patients have an improved overall survival due to the advantages of still having two fully functioning kidneys, that is, decreased risk of renal failure and associated cardiovascular issues.   With two functioning kidneys, patients are at lower risk for and from chronic kidney disease.

A partial nephrectomy is one of the more challenging procedures in urology.   This operation involves clamping off blood flow to the kidney, removing the cancerous mass entirely and repairing the kidney. The surgical team sutures the capsule of the kidney and, for deeper-seated tumors, may need to suture the tough fibrous layer inside the kidney that collects urine.   Surgeons must work promptly, so that the kidney is not denied of blood for more than 30 minutes.

To decrease the invasiveness of the kidney cancer surgery, advanced urologic teams perform the operations laparoscopically, using the nephroscope and other tools.   But partial nephrectomy using the rigid tools of conventional laparoscopy is difficult.   Lourdes urologists take advantage of robotic surgery because of the improved precision and dexterity that this technology-assisted approach offers, especially for the reconstructive portion of partial nephrectomy.   Robot-assisted nephrectomy or partial nephrectomy allows the surgeons to view the kidney better, to resect it more accurately, and to reconstruct it more exactingly.   (The Lourdes team also increasingly uses the robotic approach for radical nephrectomy, nephroureterectomy, or adrenalectomy.)

Performed through four small incisions, partial nephrectomy using robotic surgery has been found to be safe and effective for patients with simple and complex renal tumors, including hilar tumors (those present in or near the recessed point of access of the ureter and blood vessels), endophytic tumors (those growing on the interior of the organ) and multiple tumors.   The Lourdes team has recently moved to conducting a majority of its kidney cancer operations with robotic rather than conventional laparoscopy.

Finally, the Lourdes team may also use laparoscopy to destroy kidney tumor tissue with various types of energy.   For example, the urologic specialists may use surgical tools to freeze (cryoablate) small, solitary tumors in certain patients.   The approach helps patients return to normal activities much more quickly than they can after nephrectomy.

Even if the Lourdes team believes it has removed all visible cancer, some patients will also receive additional treatments, such as radiation therapy or chemotherapy or other adjuvant treatments to increase chance of cure even further.   The Lourdes urologists work as an integral part of the patient’s cancer-care team.  

Kidney Infection

Urinary infections can affect the urethra, bladder, ureter, or kidneys, causing pain, bleeding, and other symptoms.   Lourdes urologists have extensive experience screening for, diagnosing, and evaluating these infections and offering prompt, targeted, and complete medical treatment.  

Lourdes urologists are highly experienced and trained in evaluating the function of kidneys and in interventional and surgical care for all types of kidney conditions.

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