Health Scan: Surgery still sometimes needed to get rid of kidney stones

Ultrasound, laser or other energy-based devices are introduced to smash the stones in situ and "vacuum" them out.

surgery 88 (photo credit: )
surgery 88
(photo credit: )
Some people know that if a person is diagnosed with kidney stones, he can be treated non-invasively with a soundwave device called a lithotripter, which smashes the stones into tiny fragments. Another technique is to insert an optic fiber into the urinary tract to destroy the stones. But Dr. Mordechai Duvdevani of the andro-urology unit at Hadassah University Medical Center in Jerusalem's Ein Kerem notes that these treatments are not so simple, and that the condition may still require minimally invasive surgery. Writing in the latest issue of Urology Updates published by Medical Media, Duvdevani says these procedures are sometimes not successful - especially when stones are larger than 20 millimeters in diameter or very dense. In some cases, the fragments don't flush out of the body. Instead, a better technique, called percutaneous nephrolithotomy, is recommended. The urologist explains that kidney stones result when there are bacteria able to break down uric acid and allow minerals to accumulate in the urinary tract. Antibiotics are not enough to get rid of these stones, as layer after layer of minerals accumulate. Sometimes, kidneys that are congenitally shaped differently than the norm are more prone to stones. In percutaneous nephrolithotomy, which is performed under general anesthesia in one to four hours, a path is created to the kidney via the hip. Ultrasound, laser or other energy-based devices are introduced to smash the stones in situ and "vacuum" them out. Sometimes a supportive stent in inserted into the urethra that remains for a day or two. The procedure takes so long because the path must be at exactly the right location, angle and size. Sometimes a second path has to be created. The patient is hospitalized for two days to a week. Serious complications, writes Duvdevani, are rare. Nephrolithotomy can be used by a well-trained team on a wide variety of patients, he concludes, including those with chronic illness and anatomical changes in the urinary tract. As kidney stones can recur, patients should be followed up. SHOULD OUTDOOR SMOKING BE BANNED? Smokers won't like the demand by British researchers to ban cigarettes in many public spaces to help stop children becoming smokers. The British Medical Journal (BMJ) recently published a call by Dr. George Thomson and colleagues who argued that smoking bans in parks, car parks, beaches and streets will reduce smoking being modelled to children as normal. They note that the need for outdoor smoking restrictions is increasingly recognized: California has banned smoking within six meters of playgrounds, while several reports from around the world show majority support for restricting or banning smoking in outdoor areas where there are children. The authors acknowledge that we may not yet be certain that outdoor smoke-free areas reduce smoking. However, they believe that society has an ethical duty to minimize the risk of children becoming nicotine dependent. "Children need smoke-free outdoor places now to help normalize a smoke-free society," they conclude. But Prof. Simon Chapman from the University of Sydney argues that outdoor bans infringe personal freedom and that evidence for extending bans to outdoor settings is flimsy. He points out that there are few differences between the chemistry of tobacco smoke and that generated by barbecues. Zero tolerance of tobacco smoke in outdoor public settings is nakedly paternalistic, he writes. QUOTABLE HADASSAH ARTICLE An article by physicians at the Hadassah University Medical Center on Mount Scopus in Jerusalem and the Hebrew University has won an unusual honor - It was cited by Nature Medicine as the best article it had published in the field of reproductive biology during the past four years. Written in 2006 by Prof. Simcha Yagel, a leading prenatal ultrasound expert in the hospital's obstetrics/gynecology department, the article also served as the basis for a Nature Medicine editorial and was the fifth-most-cited article in the field. The researchers discovered a new function for the body's immune system that could reduce the number of miscarriages. They found that "natural killer" (NK) cells, already known for the ability to kill cells infected by viruses and infested by cancer cells, have an important role in the development of blood vessels and the migration of cells. The ability is made possible by the release of special growth factors. When new blood cells are produced (angiogenesis), a pregnant woman's placenta serves as the feeding mechanism for embryos. It is now clear that without the involvement of these cells and the substances they produce, the placenta will not develop properly, leading to miscarriage. Yagel, Dr. Jacob Hanna and Prof. Ofer Mandelboim of the HU's Lautenberg Center for General and Tumor Immunology and Dr. Debra Goldman-Wohl discovered this significant new role of NK cells by using cellular and molecular biology techniques. "It will help us treat recurring miscarriages and other conditions, and even to prevent them," Yagel said. WHEN THE GLASS IS HALF EMPTY Even "optimists" can get depressed when they lose their jobs, according to a study by researchers Ulrich Schimmack of the University of Toronto, Jurgen Schupp of the Free University of Berlin and Gert Wagner of the Berlin University of Technology. Optimists were thought to bounce back with relative ease from disappointment. But according to a UPI report, the article published in Social Indicator Research found that even those who tend to see the sunny side of things find it difficult to be unemployed. "This research addresses the age-old question: How much of our well being is determined by issues within ourselves and how much by factors outside ourselves?" Schimmack said in a statement. "We found that certain life circumstances - like unemployment - can have a significant effect on a person's sense of wellbeing, whether he's generally an optimist or not." Using interviews from German participants aged 16 to 94, the researchers determined that even optimists struggle with being out of work. While some studies show positive aspects of unemployment, such as increased leisure time, the researchers said the cons, such as the loss of income and sense of security, definitely outweigh the supposed benefits.