VA Ann Arbor Healthcare System
"Stone Dusting" - The Future Is Now, At VAAAHS
Kidney Stones Are A Growing Problem – The VA Ann Arbor Healthcare System (VAAAHS) Offers A Revolutionary Solution – New Laser Technology.
As minimally invasive surgical techniques become the way of the future, VAAAHS is ahead of the curve – poised to become a center of excellence for endoscopic laser stone surgery – VAAAHS is the only VA in the nation with an advanced kidney stone procedure called “Stone Dusting.”
“We are the first center in the VA that is able to provide state of the art laser stone surgery, and one of the first centers in the country using a system designed for ‘Stone Dusting,’” said Dr. Khurshid Ghani, Attending Physician at the VA Ann Arbor Healthcare System and Assistant Professor of Urology at the University of Michigan Medical School.
According to Dr. Ghani, the number of cases of kidney stones is on the rise – up nearly 100 percent over the past decade – they can cause considerable pain, and result in medical complications that significantly impact a person’s quality of life.
Severe flank pain, pain in the lower abdomen and groin, and nausea and vomiting are the classic symptoms, but the condition may go unrecognized or undiagnosed for several years, he said.
Whereas 1 in 20 adults reported a history of kidney stones two decades ago, nearly 1 in 11 are now diagnosed with stones during their lifetime, Dr. Ghani said – representing a significant burden on the healthcare system as annual expenditures in the U.S. exceed $10 billion.
Because the condition is linked to a number of factors that, too, are fast-growing problems in the U.S., such as increasing rates of obesity, diabetes and metabolic syndrome, the number of cases of kidney stones will continue to rise, he said.
Advanced treatment options will not decrease the likelihood of developing kidney stones, rather, they are designed to reduce surgical complications, allow fast recovery times, and reduce costs; but the most important benefit is an immediate increase in the quality of life for Veterans, Dr. Ghani said.
“Given how I feel now, I think the stone had been affecting my health for years,” said Army Veteran, Glen Cole. “I assumed the way I was feeling was due to the natural process of aging, but I found that most of the symptoms I was experiencing were gone as soon as the stone was gone. I can’t believe the difference it has made. I feel like a new person.”
Cole said he was plagued 15 years ago with a series of stones that eventually passed naturally, but had several that were too large to pass on their own, so he went to another hospital where he underwent the Extracorporeal Shock Wave Lithotripsy (ESWL) procedure.
“I was placed in a tub of water and they used a type of sonic pulsation to break up the stones. It was like a shotgun going off every half second over an extended period of time,” said Cole. “It did work, that’s the important part, but my kidneys and body were very sore. I felt like I was physically beaten by a group of people all over my body and it took several weeks to fully recover.”
Cole said he had a very different experience at VAAAHS with the “Stone Dusting” procedure.
“I was asleep for the initial phase of the procedure so I didn’t feel anything,” said Cole. “I had no pain from that point forward. When the particles of dust came out over the next 24 hours it was a little uncomfortable but still not what I would consider painful.”
According to Dr. Ghani, the effectiveness of other treatments like the ESWL procedure that Cole experienced are limited to factors such as the stone’s location, size and composition, but not as much with “Stone Dusting.”
“Improvements in the design of flexible endoscopes, laser delivery and instrumentation have meant that all stones in the kidney, regardless of location or composition, can be managed with ureteroscopic surgery,” said Dr. Ghani.
The development of miniature, flexible endoscopes that can enter the ureter and kidney to deploy small laser fibers to break up stones inside the body has revolutionized treatment options, he said – when the laser’s developer came out with a more powerful 120-Watt version last May, specifically designed for “Stone Dusting,” the VA Ann Arbor became one of the first centers in the U.S. to trial the new system.
Not long ago low-power lasers were used to break up stones into 1-2 mm pieces, and surgeons utilized baskets and other devices to retrieve the stones from the kidney, Dr. Ghani said.
The “Dusting” technique relies on a high-power holmium laser to ablate stones into fine powder, he said – the patient simply urinates out the dust over the next few days avoiding the need for basket retrieval, thereby reducing operative times and saving on costs.
With the new laser and this less invasive approach, Veterans like Dennis Harris who were “experiencing increasing levels of discomfort,” are coming to the VA Ann Arbor to have their stones dusted.
“I was avoiding surgery, but I’m very glad I got it done,” said Harris. “Now, I have no pain at all.”
Dr. Ghani said the aim is to make VAAAHS synonymous with “Stone Dusting” worldwide. To this effect, he said, he is in the midst of efforts to establish a national laser stone surgery course – hoping to teach and train residents, fellows, VA and non-VA physicians the latest techniques of endoscopic laser stone surgery – the “Stone Dusting” procedure.
“VAAAHS is in a position to create a center of excellence in laser stone surgery,” said Dr. Ghani.
What do Veterans think of “Stone Dusting?”
“I’m not sure what other procedures are like, but this one was relatively simple,” said Harris. “I highly recommend it.”