In Abington, Zapping Away Kidney Stones

Posted: December 17, 1987

The patient is strapped to an inclined stretcher and positioned against a water-filled cushion between two "image intensifiers" - tubes resembling large microscopes.

There is a bright flash and a loud pop as each shock wave is delivered to the patient's lower back.

Within 30 minutes, the lithotripter treatment reduces the patient's kidney stone to sandlike particles that can be passed painlessly through the urinary tract.

The patient is discharged the same day, and resumes normal activities within 48 hours, compared with the six weeks it normally takes patients to recover from kidney-stone surgery.

The latest technology in kidney-stone crushing and removal was demonstrated last week by Michael Dernoga, manager of Keystone Kidney Center, at the opening of the center.

The center, in the Abington Memorial Health Center at 2701 Blair Mill Road in Horsham, boasts a bathless Extracorporeal Shock Wave Lithotripsy machine that cost $4 million. It looks as scary as its name sounds, but offers almost instant relief to kidney-stone sufferers.

The center was established by a consortium of doctors and 15 local hospitals - the largest such venture in Pennsylvania, officials of the center said.

The bath-free lithotripter is the first of its kind in the area and the eighth machine of its type in the country, said David Arsht, the center's medical director.

Until 1980, surgery was the only treatment for kidney-stone sufferers. Lithotripsy, derived from a Greek term meaning stone-crushing, is faster, safer and cheaper, said Arsht.

During lithotripsy, an electrically generated pressure wave travels through water, then body tissue, to the kidney stone. Michael Dernoga, manager of Keystone Kidney Center, described the shock wave device as "a gigantic spark plug" that crushes the stone.

Lithotripsy carries a lower probability of infection and is safer, especially for patients who develop more stones and would require repeated surgery.

Early lithotripters were huge bathtub contraptions into which the anesthetized patient was lowered by an overhead crane, said Dernoga.

Keystone Kidney Center's lithotripter delivers pressure waves through a water cushion and positions the patient by way of a computer-controlled stretcher. An X-ray tube underneath the patient and a television camera in the water cushion ensure continuous monitoring.

More than five million Americans annually suffer from kidney stones. In most cases, stones do not grow large enough to require treatment and will pass spontaneously, if painfully, through the urinary tract, said Arsht. Most people don't know they have kidney stones until they pass them or the stones become lodged and block the urinary tract, he said.

"People who have kidney stones want to be treated - the pain is worse than labor" during childbirth, Dernoga said.

Arsht said the malady hits all ages and all types of people, but that the incidence is particularly high in regions with warm climates and high mineral content in the water. According to doctors at the center, Dernoga said, the Delaware Valley does not lie in the so-called "kidney-stone belt" that stretches from North Carolina to north to Washington. However, its citizens suffer a significant incidence of kidney stones due to minerals in the drinking water.

Kidney stones form when minerals are not flushed out of the kidneys. Arsht said people who don't drink lots of fluid, who are immobilized or have other urinary-tract obstructions are more likely to form kidney stones.

Dr. P. Kenneth Brownstein, a general partner in the center along with Arsht and Dr. Larry Goldstein, said the center expected to treat 1,000 lithotripsy cases a year.

Besides being one of the largest joint ventures between urologists and hospitals in Pennsylvania, the Keystone Kidney Center is one of the few lithotripsy centers that allows patients to use their own doctors, Brownstein said. Urologists certified to use the lithotripter can treat their patients at the center and have them home the same day, he said.

Dernoga said the center had the capacity to treat five patients a day. The center has a fully equipped lab to view the inside of the bladder with the latest fluoroscopic technology; a five-bed recovery room with complete cardiac monitoring, and complete radiology and laboratory facilities.

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