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First German kidney stone crusher arrives in U.S.

If you have a "surgical" kidney stone, there is only one place to be in the United States, and that is Indianapolis at Methodist Hospital. We can report unequivocally that if your stone meets the criteria for pulverizing with the new German extracorporeal (outside the body) kidney stone crusher, then you shouldn't consider any other procedure. The newly arrived equipment cost $2 million and was two years in the making by the Dornier Corporation, a German manufacturer.

We went to Germany to see this procedure at the Munich Klinikum Grosshadern when the 13th kidney stone patient was treated there. They have now successfully treated more than 1,000 patients with this most innovative method of removing stones.

There is a two-year waiting list in Germany for patients wanting to have their stones pulverized without surgery, and the miracle is that the German inventors have favored the United States with the equipment before installing more machines in Germany.

Indianapolis' Methodist Hospital officials are grateful. The Kidney Stone Formers Club is happy to further report that these Star Wars machines have also been ordered for Massachusetts General Hospital in Boston, Methodist Hospital in Houston, New York Hospital in New York City and Shands Teaching Hospital in Gainesville, Florida.

Even though 1,000 patients have been treated without side effects or complications, this was all done in Germany. Our own FDA will insist on having U.S. patients treated in this country under research protocols until it officially approves the equipment for general use. One of the provisions in the protocol for the first patients in Indianapolis will be that only stones that are actually in the kidney will be removed with the pulverizer.

In Germany, those patients with stones high in the ureter can have their stones treated with the shock waves if their stones haven't been lodged in the ureter longer than 60 days. Eventually, and after the FDA approves the equipment, kidney stones lodged in ureters will also be removed here. In some instances, stones that have slipped down into the ureter can be pushed back into the kidney so they classify for tretment in Indianapolis.

This procedure is better than surgery--and a completely non-invasive method for removing stones that once could be reached only by the most painful surgery. Patients refer to the traditional surgery necessary to remove stones as going "from the navel to the spine," a painful, debilitating affair, cutting through muscles and requiring months before their former strength is restored.

My husband Beurt's reluctance to be sidelined from his rigorous daily athletic and office activities led him to search diligently for a better way when his kidney stone was diagnosed as too large to pass. He found an obscure reference to a German doctor's use of shock waves to disintegrate stones into sand without surgery. After some study and investigation, my husband decided that this method could be a revolutionary breakthrough. Even though the doctors in Germany assured him by phone that at that time they weren't permitted to do stones in the ureter, intellectual curiosity got the better of him, and we flew to Germany to check out this exciting development. Unfortunately for him, his stone was in the upper ureter and so could not be treted under the German lithotripter protocol at that time.

However, his misfortune has resulted in great benefit for other kidney stone sufferers in this country. His efforts to bring this machine to America have borne fruit. The lithotripter is now in action in Indianapolis.

Dr. Daniel Newman of Methodist Hospital in Indianapolis tells us: "Every medical center in the world wants one of these lithotripters. They want them in Arabia, South Africa. Canada wants to buy five or ten of them right now and put them across their country because they know how cost-effective it is. Everyone is banging on their door."

His colleague, Dr. James Lingeman, adds, "Many of the patients have previously had surgery on a kidney. One of the very appealing aspects of this new technology is that it can be applied repetitively to patients without increasing the risk of damage to the kidneys. In the past, each time an operation has been performed on a kidney, that tended to increase the risk of damage or need for removal of the kidney."

The Indianapolis doctors conducting the first U.S. lithotripter procedures are totally dedicated to the patients. Dr. Phillip Mosbaugh explains: "Our feeling is that if a patient calls, we will try to handle as much as we can on the phone. We want to avoid letting people fly or drive all the way to Indianapolis and then find when they get here that they are not a candidate. That would infuriate me if I were they. To avoid that we will just tell them to send us their X-ray films through their doctor. That is how we will know whether or not we can treat their stones."

Our research certainly indicates that the lithotripter is the best possible method for removing stones that will not pass.

Lest readers be confused by reports of another method of "avoiding major surgery," let us explain other new methods for removing kidney stones. One procedure now being done at Duke University, Mayo Clinic and numerous other sites across the country is ultrasonic lithotripsy. "Lithotripsy" used in this procedure means exactly the same thing--"stone crushing." The means by which the stone is crushed, however, differs from shock-wave lithotripsy in that ultrasonic waves instead of electrically generated shock waves are used to disintegrate the stone. The ultrasonic method requires that a probe actually touch the stone before it will be able to effectively break up the stone. Therefore, a "stab wound" the size of a man's thumb is made in the patient's side and a hollow tube is inserted through the body into the kidney. Although a much quicker recovery can be expected from this operation than when the traditional 10- to 12-inch incision is made, it is still surgery and carries all the risks of surgery. Infection, laceration of the kidney or ureter and excessive bleeding are all possible, as well as loss of the kidney.

Dr. George Brannen, a urologist at Virginia Mason Hospital in Seattle, has used the ultrasonic procedure and belives the risks are "about comparable" to traditional surgery. But he notes that the patient's recovery time is cut from six weeks to one week and that there is much less pain. With this procedure the stone fragments are removed by suction rather than having to pass through the ureter.

Another approach to put the ultrasonic probe in contact with the stone is through the urethra, bladder and up the ureter into the kidney. Doctors at the University of Chicago have been inserting a small, rigid tube that can sometimes be passed all the way up to the kidney if necessary to reach a stone. The ultrasonic probe is then pushed up the tube, the stone is fragmented and the particles are collected and removed in a grasping device called a basket. The procedure does require general anesthesia, for it is quite uncomfortable, and muscle relaxation is necessary to insert the tube into the tiny ureter. It is still an invasive procedure, and infection of the kidney and other serious complications, including loss of a kidney, have resulted. In addition, in one study of 36 patients with kidney stones in the ureter and kidney, 25 percent of the patients still required open surgery to remove stones that could not be retrieved through the ureteroscope.

All the urologists we have contacted who are presently using other methods of stone removal are unanimous in proclaiming shockwave lithotripsy a superior method for treating kidney stones. They all made comments such as, "The extracorporeal lithotripter is going to be the best way to go. It's nice not to have somebody put a hole in you or make an incision for removal of kidney stones."

Any readers who have stones and are agonizing about possible surgery may feel free to call or write the following officers of the Kidney Stone Formers Club, all of whom have been to Germany to have their stones removed. These individuals are so grateful for their own good fortune in having their stones removed without surgery that they will drop whatever they are doing to help fellow stone sufferers. Dr. James Nicolette, Vice president 101 East Main Street Mount Pleasant, PA 15666 (412) 887-3195 Mr. Robert V. Bullock, Vice president 6 Warwick Lane Frankfort, KY 40601 (502) 695-5157 Mrs. Marlene Price, Secretary 463 Hinsdale Court Worthington, OH 43085 (614) 888-2252 Mr. Howard Fine, Treasurer 750 Park Avenue New York, NY 10021 (305) 358-7325

The club's president, Dr. Beurt SerVaas, can be reached at (317) 636-8881 or (317) 634-1100.

For the present, the lithotripter offers the best solution to ridding the body of kidney stones. Mrs. Marlene Price, who made the trip to Germany when she heard about the new treatment, is enthusiastic about the results of her experience. She describes the treatment in detail for the Post.

"I was diagnosed with a kidney stone when I was in the hospital for emergency surgery on another matter. I chose to go to Munich, Germany to have my kidney stone pulverized by shock-wave therapy because I felt it too risky to undergo major surgery again within a six-month period. I was hospitalized in Munich for five days. It was a totally pain-free procedure.

"On the day of the shock-wave procedure I was given a spinal anesthetic, which anesthetized me from my waist to my knees. I cwas catheterized and put on the litter, and the litter was submerged into a large stainless-steel tank of water. There were TV monitors that were showing on the screen the site of the kidney stone, and after I received approximately 100 shock waves, I was X-rayed to see that the kidney stone was actually being pulverized. With that I was administered approximately 700 more shock waves. I could feel nothing due to the anesthetic and was just aware of the intense sound. I understand some people do benefit by listening to music at that time, but that was not available that day for me. I would highly recommend that because it does get you mind on something else. I counted up to about 500, and deciced I'd better start thinking about something else. I was in the tank for about an hour. By five o'clock that evening, I no longer had a catheter, the IV was removed and I was a person without a kidney stone--just a little remaining sand in my ureter, which I passed within the next two weeks. It was an incredible procedure, and I hoped then that very soon we would have kidney machines in the United States so everyone benefits from this.

"Part of my therapy the day following the shock-wave treatment was to go to the 13th floor at the clinic in Grosshadern and 'yump,' as the Germans call it--jump down 20 stairs per floor of the 13 floors in order to benefit by gravity in helping the sand that was in my ureter pass. This treatment, along with drinking plenty of fluids, whether it be beer or water, was my postprocedure therapy.

"Having had major surgery in January, and having taken several weeks to recover after that, I know exactly what is involved, and I am so grateful that I did not have to go through that experience in order to have my kidney stone removed. This pulverization was the most incredible thing I could ever imagine."

Dr. James Nicolette, past president of the Kidney Stone Formers Club, experienced severe pain from his kidney stone prior to its successful removal in Germany:

"About three o'clock in the morning, I awoke with the most severe, excruciating pain I had ever experienced, and I thought that somebody had put a knife in my back. The pain was so excruciating that I was actually crying and praying that I would die.

"Conventional surgery entailed an incision 10 to 12 inches long extending from the navel to the spine and a hospital stay of 10 to 12 days and then a recuperative stay of possibly 2 to 6 months.

"When I got back home from Munich, Germany, and started reflecting on my experiences, I realized that I was a very lucky individual, and believe me, I've thanked God many times since then. But I happened to be on a talk show in Cincinnati where the host had about 250 people in the audience, and we started discussing renal pain or kidney pain from a kidney stone and tried to find out just how tremendous the pain is in comparison to other types of pain. He asked if anybody in the audience had had a baby and a kidney stone, and one lady had put up her hand and she did have both. He asked her which was more painful, and she said the kidney stone by far. He also asked if anybody had had a heart attack and a kidney stone. Another gentleman who had had a massive coronary put up his hand, and he also stated that the kidney pain was much more severe.

"I don't think that anybody can clearly define kidney pain, and it's been described throughout history as the most severe pain that one can encounter. After my own experiences I agree. I pray to God that I'll never have any pain like that again."

Robert Bullock, Kentucky's assistant attorney general, has had a kidney stone removed by the basketing procedure, in which instruments are used to grasp the painful offender and pull it out. A second stone was tolerated until it doubled in size and he began passing blood. After a year of waiting, he traveled to the Klinikum Grosshadern in Munich for the German procedure of crushing kidney stones.

"After I was given a type of spinal anesthetic," he says, "three men placed me on a saddle seat, fastened me in with straps across my legs and chest and secured my wrists to a crossbeam above the seat. Then a machine lifted the seat, with me in it, into the air, and I was lowered into a tank of pleasant, 75-degree water up to my chin. Earphones were placed over my ears so I could have my kidney stone crushed to the strains of Beethoven."

Two X-rays of the stone were taken from different angles. The positioning of the X-ray cameras and the seat on which he sat was accomplished by remote control. Once everything was in position, the lithotripter caused an electric spark to hit the water and sent shock waves into his body on their way to the stone. After a series of 45 such waves, X-rays checked the progress of the stone's disintegration, and the treatment resumed, this time in 100-shock segments.

"After each 100-shock segment, new X-rays were taken and the machine repositioned. In all, my stone being so large, I had over 1,200 shock waves. During part of the procedure I fell asleep," says Mr. Bullock.

As Bullock emerged from the tank, "control" X-rays showed his stone to be disintegrated, leaving a great deal of "dust" in the kidney. The next morning, he was out of bed and feeling only a slight discomfort. He was told to drink at least three liters of fluid and to do a lot of walking. "Two weeks later, the particles began to pass in large quantities," says Mr. Bullock, "and the discomfort subsided, then ended." He has had no stones or problems since the procedure.

Since lithotripsy, Mr. Bullock has changed his diet to decrease a high triglyceride level found in Germany. He found that by cutting out caffeine and refined sugar and decreasing fats and meats, he not only lowered the triglycerides but was able to control his gout strictly with diet. He has stopped taking the medication for gout and has had no recurrence of either his gout or his kidney stones.

If any of our readers have had experiences with stone removal that they think might help others in making their decisions about surgery versus other methods, please send them to the editor of the Kidney Stone Formers Club Quarterly if you are willing to share them.

When I first met Dr. Nicolette he was in a small Illinois hospital about to be treated by a nonsurgical method of direct-contact shock therapy and high basketing, which carries a dangerous risk of damaging the ureter. A patient that very day had just had his ureter severed in the attempt to basket a high ureter stone, a procedure that has always been considered imprudent by conservative urologists. Fortunately, a Kidney Stone Formers Club member's misfortune gave Dr. Nicolette ample warning and incentive to leave that hospital and to seek the German treatment instead. The victim, who lost his kidney due to the severed ureter, is now the president of the Kidney Stone Formers Club.

"New and exciting things are happening in the area of treatment for kidneys stones," Dr. James Lingeman tells us. "Any institution or organization that can help improve communication and spread information regarding these new developments can only be helpful," he says of the newly formed National Kidney Stone Registry.

We encourage all kidney stone formers to fill out this questionnaire and mail it. If you are not a stone sufferer, cut it out and give it to someone who is. We will enter all the information in our computer and share it not only with the American Urologic Association but with all nephrologists and endocrinologists who wish to use it as they search for ways to help prevent stone formation. We will keep you updated through our articles in the Post and through the Kidney Stone Formers Club Quarterly.

Membership and the quarterly newsletter are available to anyone making a tax-deductible contribution of $10 or more per year toward kidney stone research efforts.

Please send your questions and case histories regarding successful kidney stone treatments and/or removals as well as your contributions to: The Kidney Stone Formers Club, 1100 Waterway Blvd., Indianapolis, Indiana 46202.
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Author:SerVaas, Cory
Publication:Saturday Evening Post
Date:Mar 1, 1984
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