Kidney stones are a common problem, affecting nearly one in ten Americans. According to the National Kidney Foundation, more than half a million people go to emergency rooms for kidney stone problems every year.
Urologists at Washington University School of Medicine in St. Louis offer comprehensive kidney stone care with a focus on minimally invasive techniques, even for the largest stones. Many trainees in urologic surgery are interested in kidney stones and endourology—the specialty of using scopes and small instruments to look inside the body for the minimally invasive treatment of such conditions as kidney stones and benign prostatic hyperplasia (BPH). Washington University was one of the first centers to offer ureteroscopic stone treatment (URS), and residents learn these skills from fellowship-trained faculty in a five-year residency program with high clinical volume and diversity of cases.
This August, Urology residents at the School of Medicine participated in a hands-on Endourology Skills Course at Barnes-Jewish Hospital. As part of this training, residents practiced breaking and removing stones in a simulated educational environment. Residents had the opportunity to train in ureteroscopy, which is the preferred treatment method for small-to-medium sized kidney stones. Ureteroscopy skills stations utilized different flexible scopes and lasers, including the newer Moses laser.
Residents also took part in percutaneous nephrolithotomy (PCNL) training, which is the preferred treatment method for large kidney stones or a large number of smaller stones. PCNL skills stations helped residents learn how to gain access using different imaging modalities (like ultrasound and fluoroscopy), how to dilate the access tract and how to break up and remove the stones.
There were also skills stations dedicated to the management of BPH, utilizing different technologies including Greenlight, HoLEP (holmium laser enucleation of the prostate) and Rezum.
“This skills course was made possible by industry partners from Boston Scientific, Cook Medical and Karl Storz,” says Erica Traxel, MD, Director of the Urology Residency Program. “Our faculty worked closely with these partners to develop a robust educational opportunity for residents. Our residency program stages similar hands-on simulation labs throughout the year, focusing also on other skills like insertion of penile prostheses and artificial urethral sphincters and urethral slings. Modern surgical training should include simulation opportunities.”
Expertise in Endourology
In addition to training residents in endourology, Washington University offers fellowships in laparoscopic and robotic urology and endourology, led by Clinical Fellowship Director R. Sherburne Figenshau, MD, the Taylor Family and Ralph V. Clayman, MD Chair in Minimally Invasive Urology.
The Endourological Society fellowship training, tailored to fit the fellow’s desired experience and post-fellowship career goals, focuses on developing advanced knowledge, experience and technical skills in endourologic, laparoscopic and robotic urologic surgery.
Faculty in the division are also national leaders in kidney stone research and clinical trials.
Alana Desai, MD, Assistant Professor of Urology, and Henry Lai, MD, Associate Professor of Urology, are principal investigators in the Prevention of Urinary Stones with Hydration (PUSH) study.
Funded by the National Institutes of Health and National Institute of Diabetes and Digestive and Kidney Diseases, the PUSH study is a multicenter randomized clinical trial of kidney stone patients to look at whether changes in behavior, including drinking more fluids, will help prevent stone disease progression over a two-year period. The study uses a smart water bottle to measure the amount of fluid participants drink, and offers financial incentives and access to health coaching for members of the experimental arm.
The Division of Urology is the highest recruiting site for the PUSH study.
Washington University Urologists are experts in identifying the causes of kidney stones and how to prevent stones with alterations in diet, behavior or medical therapy. Washington University Urologists at Barnes-Jewish Hospital are consistently among the Best Doctors in America, and are U.S. News and World Report nationally ranked leaders in patient care.