By Eugene Kramolowsky, MD
Patients who are unable to pass their stone or have significant pain often elect to undergo a procedure to fragment or remove their stone. The least invasive commonly used procedure is extracorporeal shock wave lithotripsy (ESL). This procedure fragments the stone without the need of instrumentation. Over 20,000 ESL procedures have been performed in the outpatient surgery center of Virginia Urology since 1992. Recent modification of the shock rate has resulted in a documented increase in stone fragmentation and passage with a resulting decrease in ancillary procedures and reduced costs.
The other procedure for removal or fragmentation of stones is done via ureteroscopy which requires advancing a scope into the ureter to engage the stone. Nearly 1000 of these procedures are done per year at the Urosurgical Center of Virginia. This procedure results in immediate relief of ureteral obstruction which is the cause of renal colic. Because of flexible scheduling, the surgery center is often able to deliver ureteroscopy to the patient sooner and perhaps more efficiently than the hospital based operating rooms. Our patients appreciate quick resolution of their pain and return to work and activities.