211 Fountain Ct., Suite 230
Lexington, KY 40509
The Lexington Clinic
Advanced Kidney Stone Surgeries
Ambulatory Tubeless PCNL (Percutaneous Nephrolithotomy) and Stentless MiniPCNL
Percutaneous nephrolithotomy is a surgical procedure to remove kidney stones that are too large to pass on their own or don’t respond to other treatments. It has the highest stone free rate of any kidney stone surgery. The procedure is outpatient and takes 1-2 hours to complete. Risks include blood in your pee, blood clots, infection and healing problems. Recovery takes 1-2 weeks. Usually patients go home same day with just a ureteral stent. Dr. Todd enters the kidney through a tiny incision and breaks up and vacuums out the stone with a special scope and an ultrasound wand.
Dr. Todd specializes in this procedure, has performed several hundred, and uses the latest technology with ultrasound guidance to minimize radiation, as well performing the procedure supine (patient facing up), which requires less anesthesia and allows quicker recovery. In some instances, this surgery totally tubeless without even a stent or nephrostomy tube when done through a smaller sheath. This is referred to as totally tubeless (scentless) Mini PCNL. This is an area of interest that Dr. Todd has lectured on across the country, and is the only surgeon in KY that offers it.
Vacuum-assisted Ureteroscopy
Another area of advancement in minimally invasive kidney stone surgery is the addition of vacuum assistance to ureteroscopy (see below). Ureteroscopy has been the gold standard for removal of obstructing stones in ureter and smaller stones in the kidney for some time, largely replacing shock wave lithotripsy. One recent technological addition that has further widened this gap, increasing the stone free rate with ureteroscopy, is the addition of vaccum channels to ureteroscopes (Calyxo CVAC) and access sheaths (Clear Petra). Dr. Todd employs the latest technology to try and achieve the best results for each patient.
Ureteroscopy with laser lithotripsy is an outpatient endoscopic procedure, where the surgeon uses a tiny telescope (a ureteroscope), to travel through the urethra and bladder, up the ureter (the tube that connects the kidney to the bladder) and find the stone. A small laser fiber is then used to break the stone into dust or small pieces. After the procedure, a stent is left in for 5-7 days to allow the inflammation to reside. It is then removed in the office or at home.
Metabolic Kidney Stone Management and Prevention
It all starts with a proper evaluation and workup
Kidney stones affect many people, especially in Kentucky. The national prevalence is 10%, whereas in KY it is closer to 20% in some studies. There are many factors that influence this. Dr. Todd performs a full assessment with a 24 hr urine collection, blood tests, and a careful history (dietary, family, and medical) to get to the bottom of why each person makes stones. He can then work with you to create a customized prevention plan.
Advanced Testing
As with many diseases, we are now learning more about genetic factors that contribute to kidney stones. There are now commercially available DNA/RNA tests to identify those with genetic disorders. Furthermore, there are now monoclonal antibody treatments for some of them, like primary hyperoxaluria. Dr. Todd is one of the only providers in central KY to offer this testing and treatment.
Supplements
There are a number of supplements available on the internet today, some with very good evidence for stone prevention, others merely marketing. Having a Urologist that is familiar with all of them and can help you discern the two is key.