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B Y J AN H OWARD

People who suffer from kidney stones may be spared major abdominal surgery

through the use of a safe, painless, and highly effective treatment now

available at local hospitals.

The procedure, lithotripsy, is a non-invasive procedure that uses mild shock

waves to break up kidney stones.

The portable HealthTronics Lithotron with fluoroscopy and ultrasound will be

shared by several area hospitals, including Danbury, Waterbury, and St

Vincent's Medical Center in Bridgeport, through a mobile unit.

The State of Connecticut Office of Health Care Access recently approved the

new service that will allow area residents to be treated faster and closer to

home. Connecticut Lithotripsy, a newly formed company located in Farmington,

will offer portable lithotripsy services throughout the state.

The unit will be in operation one day a week at St Vincent's and Waterbury

Hospital and a half day every other week at Danbury Hospital. As many as six

to eight patients can be accommodated per day.

The lithotripsy technology was developed in Germany in the late 1970s and

early 1980s, Dr James Roach, chief of the Division of Urology at St Vincent's,

said. The treatment has been available in this country for 15 years, but until

now patients had to travel to UConn's John Dempsey Hospital in Farmington or

to Yale-New Haven Hospital to receive care. Typically there was a one- to

two-week wait before treatment could be provided.

According to Dr Roach, the Cost Commission, a state agency, only allowed the

one machine up to this time. "You have to get their approval for additional

services at hospitals," he said.

"We're very excited," Dr Jeffrey Gorelick, a urologist at Danbury Hospital,

said, adding if Danbury Hospital has more volume, there are additional time

slots available.

Dr Gorelick said he was affiliated with New York Hospital's Cornell Medical

Center early in the 1980s when it had one of the first four lithotripsy

machines in the country.

He said he believes that lithotripsy, which is also referred to as ESWL (extra

corporeal shock wave lithotripsy), was one of the biggest medical inventions

in this century. "It is completely non-evasive," he said.

Dr Gorelick said stones in the upper ureter or in the kidney are best treated

with lithotripsy.

Dr Gorelick said Connecticut doctors have been fighting for more machines for

some time.

"The costs (for the procedure) are higher in Connecticut because previously

there was no competition," he said.

He said because of the great demand for time at UConn and Yale-New Haven, he

could only schedule two patients two times a month.

"For 10 years years, I have been traveling twice a month an hour each way to

treat two people," Dr Gorelick said. "Some of my patients from New York had to

travel one and a half hours each way.

"We do all the most modern techniques, but the one treatment option we were

missing was this. Now that piece of the puzzle is fitted," he said.

Dr Scott Kantor, a urology specialist at Waterbury Hospital, said the first

mobile van is already in place.

He agreed the availability of the original machine, which alternated for a

week at a time between UConn and Yale-New Haven, caused difficulties in

scheduling and traveling time for patients and doctors. Because the procedure

will be available locally, service should be more prompt, Dr Kantor said.

"We expected it to take years before this technology became available

locally," said Dr Jeffrey Wolk, a urologist at Waterbury Hospital. "It is an

excellent piece of technology."

The Lithotripsy Procedure

Lithotripsy is the most common treatment for a kidney stone, according to Dr

Roach.

"Lithotripsy is a non-surgical technique that gets patients back on their feet

within days rather than the three to four weeks required following major

abdominal surgery," he said.

Dr Roach said the location of the stone is first determined from an x-ray.

During the procedure, the patient is positioned on a table with his or her

back against a round cushion, which is filled with water. At the bottom of the

cushion there are two electrodes that produce powerful shock waves that pass

through body tissue and muscle, focusing on the calcified kidney stone.

Once focused, the shock waves cause the kidney stone to disintegrate into tiny

particles that can be passed from the body. Throughout the procedure, the

patient is monitored with fluoroscopy.

The machine produces 120 shocks a minute, with a maximum of 3,000 used during

a procedure, which takes about 35 to 40 minutes.

Prior to the procedure, a local anesthetic is given, and intravenous sedation

is used during the treatment so the patient doesn't move. Dr Roach said that

because the patient is not completely sedated, "it feels like someone is

hitting you in the back, but not hard."

The patient spends a total of about three to four hours in the hospital, which

includes an hour in recovery, Dr Roach said.

Usually one procedure is enough, though in some cases a second treatment might

be necessary. "Twenty-five percent might need a second treatment," he said.

The shocks do not harm any other area of the body, and side effects are

usually minimal. Dr Kantor said the patient sometimes feels a little sore

after the procedure. There also may be mild bruising.

Dr Kantor cautioned that the procedure is not for everyone because it may not

always work. Once the kidney stones break up, they don't always pass, and

surgery or some other treatment option may still be required.

The procedure, which costs about $5,000, is covered by most insurance

policies, Dr Roach said. "It's not inexpensive, but it's less than if you were

in the hospital for surgery."

Kidney stone disease

Kidney stone disease is the most common urological disease, affecting two to

three percent of the population. More than a million Americans are treated

each year for kidney stones. About 60 percent of the patients are men.

The first sign of a kidney stone is excruciating pain. It is considered one of

the most painful and mysterious disorders to afflict human beings, according

to information prepared by Connecticut Lithotripsy.

Typically, the individual experiences sudden onset of pain in the back and

side near the kidney or in the lower abdomen. Later, the pain may radiate to

the groin.

Kidney stones occur when minerals normally found in the urine crystalize. The

stones hurt because they obstruct the flow of urine from the kidney into the

bladder.

Some people are at high risk for developing kidney stones, including those

with a family or personal history of them. But most of the time, it seems to

be a random occurrence, Dr Wolk said.

Dr Kantor said kidney stones are sometimes genetic. They may also be caused by

metabolic irregularities. "There are certain kinds of stones that are

associated with infection or other diseases," he said.

In most cases, kidney stones are not related to diet.

Diagnosis by a urologist includes an extensive investigation of a patient's

medical history, physical examination, routine blood and urine tests, as well

as routine x-rays, kidney ultrasound or an injection of dye with kidney

x-rays.

According to Connecticut Lithotripsy, treatment options in the past have

largely been surgical. With non-invasive lithotripsy, no cutting is involved.

Generally, no inpatient hospital stay is necessary.