Offering rapid, effective, personalized kidney stone treatment to patients requires the synergy of expert clinicians, ample support staff, and up-to-date facilities, according to Ryan Hsi, M.D., an assistant professor of urology at Vanderbilt University Medical Center. “But the point is not just to take care of a stone when the patient has symptoms; it’s also about figuring out why they are making those stones and coming up with a personalized plan to prevent them,” he said.
Hsi and his colleagues have established a new stone center for the care of adult patients at Vanderbilt Health Belle Meade that incorporates these elements, where they also conduct kidney stone research. When children need care for kidney stones, they receive treatment at Monroe Carell Jr. Children’s Hospital at Vanderbilt.
“Prior to establishing the center, we had to reserve a lithotripter from mobile lithotripter services owned by third parties. That’s the usual approach,” Hsi said. Booking those machines immediately or on short notice was not a sure thing, meaning that patients often had to wait.
A Constellation of Components
“When we set out to improve kidney stone care in the region, we realized you can’t just do one thing … hire more people, build more clinic rooms, or add new equipment,” Hsi said. All those things had to happen simultaneously, he added, because they rely on each other.
“The point is not just to take care of a stone when the patient has symptoms; it’s also about figuring out why they are making those stones and coming up with a personalized plan to prevent them.”
The new center is located close to an interstate highway to improve access to care, and has ample space (procedure rooms, clinic rooms, and operating rooms), equipment and human resources. “We hired only fellowship-trained clinicians or those who specifically focus on kidney stones,” Hsi said.
Hsi’s team also hired a patient care coordinator, increased outreach to primary care providers in the region, and established a toll-free number for new patients. Patients can now schedule same-day or next-day appointments.
Specialty Equipment at the Center
The Vanderbilt Stone Center recently acquired a multifunction urological workstation, the MODULITH® SLX-F2 connect. The center is one of only a few equipped with a comparable piece of equipment, Hsi said. “It combines everything needed to diagnose and treat stones – including an excellent lithotripter with a table and the newest imaging equipment available.”
Hsi and his team also employ up-to-date state-of-the-art laser lithotripsy technology, including the Moses™ 2.0 holmium laser and thulium lasers, for the most efficient, effective stone fragmentation.
“Those lasers have barely been out for a year,” Hsi said, adding that medical facilities normally keep lasers for many years before trading up for the fastest, most efficient devices.
In addition to shockwave lithotripsy, the center offers ureteroscopy and mini and standard percutaneous nephrolithotomy. Hsi and colleagues have published their results on enhanced recovery after surgery with multimodal medications. Overall, this means that each patient can have a customized, potentially opioid-free, treatment plan for their unique situation.
“Prevention is just as, if not more, important for kidney stones,” Hsi said. The stone center performs metabolic evaluations that can lead to nutritional advice, medications and surveillance plans tailored for each patient. For the more complex cases, Hsi co-leads a joint urology-nephrology clinic with Edward Gould, M.D, an assistant professor of urology at Vanderbilt, that offers shared visits and access to dieticians.
“I see my job as saying to the patient, ‘Based on your history and imaging, this is what makes you different from other people, and these are your best options because of that.’”
Personalized Treatment Plans
Patients have different priorities when choosing treatment modalities for their stones, Hsi noted. The center’s arsenal of treatment options means patients can choose what is best for them.
“One may want the fastest recovery with the least invasive shockwave lithography so they can get back to work the next day, even though that might mean a higher possibility of residual fragments,” he explained. “Another patient may choose a slightly more invasive approach, with ureteroscopy, because they want to have a better chance clearing all of the stone in one procedure, even if it means possibly having to have a ureteral stent in place for a few days.”
Patients can become overwhelmed by all the information they find online, on top of advice from friends and relatives, Hsi said. The center’s team help patients sort through it all. “I see my job as saying to the patient, ‘Based on your history and imaging, this is what makes you different from other people, and these are your best options because of that.’”