Washington University Stone Center

Physicians may call (314) 454-5999 to make a referral.

The Washington University Stone Center provides comprehensive kidney stone care including stone elimination and stone prevention.

Our services

• Rapid-access stone clinic where patients are given a quick appointment to see a specialist. (Dedicated Stone Line: 314.454.5999)

• Treatment of simple and complex stone conditions.

• In-house new metabolic stone laboratory services for prevention of stones.

Our first priority is to promptly relieve pain from kidney stones and remove stone(s) or facilitate spontaneous stone passage. Then we seek to identify the risk factors for stone disease with appropriate blood and urine tests at our metabolic stone laboratory. Following this, we provide specific fluid and dietary recommendations including medical therapy with close monitoring to prevent new stone formation.

Experience Counts

• Certified urologists who care for a large volume of patients and are fellowship trained to treat complex stone disease.

• Qualified, experienced technicians have provided more than 10,000 stone lithotripsy and laser treatments.

Our Technology

• Extracorporeal shock wave lithotripsy (SWL) with highly effective stone-busting machine

• Percutaneous nephrolithotomy to remove large kidney stones

• Ureteroscopic stone removal with the latest flexible scopes, laser and other energy devices

Two Convenient Locations

• Barnes-Jewish Hospital
• Barnes-Jewish West County Hospital

Physicians may make a referral by calling the dedicated Stone Line at 314.454.5999.

To make an appointment, patients may call (314) 362-8200 (Center for Advanced Medicine and Barnes-Jewish West County Hospital).


Our Physicians

• Alana C. Desai, M.D.
• Brian M. Benway, M.D.
• Sam B. Bhayani, M.D.
• R. Sherburne Figenshau, M.D.

Frequently Asked Questions

What are kidney stones?
Normally, urine has chemicals that prevent crystals from forming. Sometimes substances in the urine (like calcium and other materials) become concentrated in the urine and form solid crystals. These crystals can lead to stone development when material continues to build up around them.

But what happens when you start to have a pain in your back or side or you are having urinary infections? You could be one of the thousands of people with kidney stones.

Most stones contain calcium, but uric acid, struvite and cystine make up other types of stones.   The majority of stones form and grow in the kidneys, and with time, they may move around within the organ. Some stones may be washed out of the kidney by urine flow and end up trapped within the ureter. Stones usually cause symptoms when this happens because they block the outflow of urine leading to the bladder.

Symptoms may be different, but most often, patients will complain of pain centered in their sides, which may also radiate toward the front of the abdomen or to the groin area. At times, the pain may become so severe that the patient becomes unable to find a comfortable position. Blood in the urine may also appear when a stone is present. In some patients, especially those with diabetes, a fever may develop from infected urine that becomes trapped behind a stone. This is a medical emergency because a bacterial infection that is not drained can cause serious sepsis (a toxic condition in which bacteria or their products spread from a focus of infection).

How prevalent is stone disease?
Approximately 12 percent of men and 7 percent of women have a lifetime risk of being affected by stones – usually in their 20s to 40s. Of these patients, 50 to 80 percent will have a recurrence within 5 years of their first stone, unless the disease cycle can be interrupted.

What are risk factors for kidney stones?

• Dehydration
• Dietary factors (high protein and/or high salt diet)
• Family history of stones
• Metabolic factors

Treatment
There are a few different ways to treat kidney stones, depending upon the patient's medical condition, where the stones are, how big the stones are, and sometimes, what the stone consists of. There are four main surgical treatments for kidney stones. They are shock wave lithotripsy (SWL), ureteroscopy, percutaneous nephrolithotomy (PNL) and open surgery.

Shock wave lithotripsy (SWL). This is a completely non-invasive form of treatment (no skin incision or internal telescopic procedure) in which an energy source produces a shock wave that is directed at a urinary stone within the kidney or ureter. Shock waves go through the patient either through a water bath, in which the patient is placed, or using a water-filled cushion that is placed against the skin. Ultrasound or fluoroscopy is used to locate the stone and focus the shock waves.

SWL usually is performed with the patient under general anesthesia. Once the treatment is completed, the small stone particles then pass down the ureter and eventually are urinated away. Sometimes, the doctor has to place an internal stent in the ureter to help the urinary drainage. A stent is a plastic device that resembles a straw – it holds the ureter open and facilitates stone passage and urinary drainage. Patients who have this procedure usually go home the same day and can get back to normal activity within two to three days.

Ureteroscopy. This treatment involves the use of a very small, fiber-optic flexible instrument called a ureteroscope, which allows access to the stones in the ureter or the kidney. It allows the urologist to look directly at the stone by passing the scope up the ureter by way of the bladder. No incisions are necessary, but general anesthesia is used.

Once the stone is seen through the ureteroscope, a small basket-like device can be used to grab the smaller stones and remove them. If a stone is too big to remove, a laser fiber can be passed through the ureteroscope and the stone can be fragmented. If the doctor has to do much maneuvering to crush the stone, a stent may be placed to drain the kidney until the swelling due to the procedure resolves. Occasionally, the stent itself can cause some symptoms.

Patients normally go home the same day and can get back to normal activities in two to three days.

Percutaneous nephrolithotomy (PNL). PNL is the treatment of choice for large stones within the kidney that can't be effectively treated with lithotripsy or ureteroscopy.

The procedure is performed with the patient under general anesthesia. The main advantage of PNL, when compared with traditional open surgery, is that only a small incision (smaller than an inch – like a keyhole) is required in the side. The urologist then places a guide wire through the incision into the kidney under X-ray guidance, and it is then directed down the ureter. A passage is created around the wire with dilators providing access into the kidney.

An instrument called a nephroscope is then passed into the kidney to look at the stone. Using an ultrasonic probe or a laser, the stone is pulverized. Because the tract allows passage of larger instruments, the urologist can suction out or grab the stone fragments. This is effective for patients who have larger stones – usually more than 2 to 3 cm.

Once the procedure is done, a tube is left in the side to drain the kidney for a couple of days. This usually is removed before the patient is discharged home.

Most PNL patients spend two to three days in the hospital.

After the clearance of stones, blood and urine tests are done to determine risk factors for stone formation. Stones are also analyzed chemically to identify their composition. This helps to plan treatment to prevent future stone formation. Patients who have kidney stones have up to a 50 to 80 percent chance of redeveloping stones within five years.

More on stone disease from the American Urological Society .

For comprehensive stone treatment and prevention, physicians may contact the Washington University Stone Center at 314.454.5999.