The two images above are of the same kidney, which is filled with stones. The left image is an X-ray used for diagnosis. On the right is the image that the urologist obtained from an endoscope – a narrow tube with a camera at the end that is inserted into the body. The urologist viewed the endoscopic image while removing the kidney stones.
Just below the rib cage on either side of the spine are two fist-sized organs that are vital to our survival – our kidneys. They each have about a million microscopic filters called nephrons, which process all of the blood in our bodies several times each day. This process filters toxins from about 150 quarts of blood, creating up to two quarts of urine that contains wastes and excess bodily fluid. The urine drains down tubes called ureters to the bladder and is emptied from the bladder through a tube called the urethra.
The kidneys are important to our health for many reasons. They prevent the buildup of wastes and fluid in the body. They stabilize electrolytes such assodium, potassium and phosphate, which are essential for the normal functioning of our cells and organs. And they generate hormones that help produce red blood cells, regulate blood pressure and maintain bone strength.
Sometimes the kidneys slowly stop functioning. Without treatment, this decline can progress to chronic kidney disease, also called chronic renal insufficiency or chronic kidney
failure. The cause of chronic kidney disease is not always known, but any condition that damages blood vessels can negatively affect the kidneys. One common cause is
diabetes, because elevated blood sugar levels over a long period of time damage the kidneys’ blood vessels. There is also a relationship between kidney disease and high blood pressure (hypertension). High blood pressure can damage blood vessels, and if that causes kidney disease, the failing kidneys, in turn, can cause even higher blood pressure.
Preventing Kidney Failure
When kidney function falls below a certain point, it is called kidney failure. As with any condition, the earlier kidney disease is detected, the sooner treatment can begin to slow down its progression and prevent kidney failure. The first step is to determine and treat the underlying cause. Since diabetes and high blood pressure account for 66 percent of chronic kidney disease, preventing or managing those conditions through diet, exercise and appropriate medication is vitally important in protecting the kidneys.
It is possible to survive with only a part of one kidney if it is still functioning. If neither kidney works, however, a machine has to be used to clean the blood (dialysis) or a new kidney has to be transplanted.
Phelps offers patients a higher level of care for the prevention of renal diseases and disorders than is typically available at community hospitals. “My colleagues and I are experienced in performing the most advanced laparoscopic and minimally invasive reconstructive procedures through small access sites without large incisions,” says urologist Michael Grasso, MD. “As a result, our patients heal more quickly and are able to return to normal activities much sooner. There is also less pain than with open surgery.”
Dr. Grasso adds, “In general, urologists who have broad surgical experience with the latest technology and who follow a surgical team approach are able to provide improved treatments and better patient outcomes for conditions such as kidney stones, ureteral obstruction and kidney cancer.”
Kidney stones are formed from the crystallization of certain substances in urine, such as calcium, oxalate, or uric acid. The stones can affect any part of the
urinary tract – from the kidneys to the bladder. Kidney stones are more common among men.
Symptoms of kidney stones include severe pain in the side and back below the ribs, which may spread to the lower abdomen and groin. Pain may be in waves and fluctuate in intensity. Urine is usually red, brown, pink or cloudy and may be foul smelling. Fever and chills occur if there is an infection.
Small kidney stones often pass out of the body in the urine and may go completely unnoticed. But in the ureter, larger stones can block the flow of urine and be excruciatingly painful as they move toward the bladder. Painful or not, kidney stones usually do not cause any permanent damage.
While drinking large quantities of water is sometimes all that is necessary to pass a kidney stone, if the stone is large, a procedure by a urologist may be the only solution.
The good news is that kidney stones can often be eliminated without any surgical incisions, usually in an outpatient setting. In a procedure called ureteroscopy, a small viewing instrument called a ureteroscope is inserted into the urethra, through the bladder and the ureter to where the kidney stone is located. Once the stone is in view, the urologist can capture it with forceps or a basket. Another non-surgical technique, Extracorporeal Shock Wave Lithotripsy (ESWL), uses shock waves to break larger stones into pieces small enough to pass in the urine. The best method for eliminating very large, complex kidney stones is Percutaneous Nephrolithotomy (PCNL), which involves a small incision and placement of a tube into the kidney through which instruments can be introduced to break up and remove the stone.
The yellow line outlines a polypoid tumor – so called because it has the appearance of a polyp. The urologist removed the tumor endoscopically, saving the kidney.
Urine travels from the kidneys to the bladder through thin, muscular tubes called ureters. There is one ureter for each kidney, and each is 8 to 10 inches long. Sometimes the ureters become blocked and the flow of urine to the bladder is impeded.
The most common cause of ureteral obstruction is ureteral or kidney stones. Other causes include congenital conditions, scarring or injury from previous abdominal or pelvic surgery, blood clots, tumors, ureter wall swelling, inflammation of organs around the ureters, a tiny swelling in the ureter called a ureterocele, endometriosis, severe constipation and pregnancy.
Symptoms include pain in the lower back or lower belly toward the sides, painful urination, increased urinary frequency or urgency, reduced urine output, blood in the urine, swollen legs or fever.
To diagnose ureteral obstruction, a urologist will conduct a physical exam, measure blood pressure and check for blood or infection in the urine. An abdominal ultrasound or CT scan may also be done.
The goal of treatment is to reduce or eliminate the blockage. Severe cases usually require surgery to repair the underlying cause of the obstruction.
In this 3D CT image, the white arrow points to a blockage in the kidney where accessory vessels crossed. The urologist reconstructed the drainage portion of the
kidney and moved the extra vessels away from the blockage, restoring kidney function.
The incidence of kidney cancer is growing in the United States. Fortunately, most kidney cancers are detected before they metastasize (spread) to other organs.
Historically, a diagnosis of kidney cancer led to removal of the entire kidney in an operation called a nephrectomy. Today, the majority of kidney tumors are removed in a partial nephrectomy, in which advanced laparoscopic techniques and special imaging are used to remove the tumor and some tissue around it without a large incision. The healthy part of the kidney is saved, and good kidney function is maintained.
Additionally, techniques using tiny endoscopes (lighted, flexible instruments for visualizing inside the body) and powerful, precise lasers are used to treat tumors on the lining of the kidneys, ureters, and bladder, removing malignancies while saving the remaining organ.
In fact, with these new techniques for treating kidney cancer, the entire organ is rarely removed.
In this image, the area outlined in blue is cancerous, the area outlined in yellow is a cyst. The red outline indicates the portion of the kidney that was removed. The rest of the kidney was saved.
Michael Grasso, MD, is Professor and Vice Chairman of the Department of Urology at New York Medical College, as well as Regional Director of Urology for the North Shore-LIJ Health System. He annually teaches instructional courses in advanced urological procedures at the American Urologic Association meeting and the European Urologic Association meeting. Dr. Grasso and his colleagues, Andrew I. Fishman, MD, and Christopher Dixon, MD, specialize in leading-edge, minimally invasive procedures for the treatment of kidney disease. Dr. Fishman is an Assistant Professor and Dr. Dixon is Director of Reconstructive Urology at New York Medical College. Their Westchester office is on the Phelps campus in the 755 North Broadway building, Suite 510. The urologists perform outpatient and inpatient surgical procedures in the new SurgiCenter at Phelps. To contact Dr. Grasso, Dr. Fishman or Dr. Dixon, call 914-302-0100.