Once a patient has been diagnosed with a kidney stone, there is a process to be followed to determine what treatment is best. If a doctor feels that surgical treatment is probably necessary, they are asked to send to the Center xrays or imaging studies from the patient, a medical history and physical exam, insurance information; and patient information including name, address, and telephone number so the patient can be contacted. The Center then reviews the medical information, verifies the insurance coverage, and the urologists at the Center review the case and studies making a recommendation as to the best treatment. We do have a procedure for handling cases where there is no insurance coverage.
There is a mandatory second opinion to verify the proposed treatment. If the case is to be treated at the Center, the case is then scheduled with the patient and referring doctor's office. Once scheduled, the patient is given specific instructions as to diet, when to stop eating and drinking, and what medications to take and what not to take. (See the restricted Medication list) The patient is told when to appear at the Center for treatment. If these instructions are not followed, the case may be cancelled. The patient and referring urologist are also told what laboratory tests are necessary before treatment. Depending upon the patient's medical condition the tests required may be minimal or extensive and may include blood tests, urine tests, x-rays, and cardiograms. These tests should be done 1-2 weeks before surgery and should be sent to the Center. Our staff reviews all the information 1-2 days before treatment to insure that treatment will be safe.
The patient is asked to arrive at the Center 1 to 1-1/2 hours before surgery is to start. The patient is prepared for surgery, an IV is started, and informed consents are done by the treating anesthesiologist, urologist, and nurse. Postoperative instructions are given. Each treatment takes an average of 1 to 1-1/2 hours. The patient must recover from the procedure in the recovery room before discharge. Total time at the Center is usually 4-5 hours. The patient must arrange to have a responsible adult transport them at discharge. No patient is allowed to leave alone.
After discharge, the patient's referring urologist resumes the patient's care. Usually, normal diet, normal physical activity, normal sexual activity can be resumed 24 hours after surgery. If the patient has questions or problems, they are to call the referring urologist. All patients are asked to see the referring urologist one to two weeks after surgery. The followup visit is extremely important to determine if the procedure was successful and to check for any problems. More than one postoperative visit may be necessary.
The postoperative visit is a good time to talk with the urologist about how to prevent future stones. The referring urologist is required to send a report back to the Center giving the outcome of treatment. If a stent is present at discharge, this must be removed in a timely fashion, usually within 4-6 weeks of being put in. If not removed, severe complications can occur, including the rapid formation of new stones. If the patient is a "stone former," it is advisable to see the urologist every year in the future to check for the silent formation of new stones.