Includes Index

About one person in ten will have a urological stone over their lifetime. Also
about 60–70 % of those individuals will have recurrent stones! This well written, clearly articulated and comprehensive book about urolithiasis, urological
stones, by an expert in the field, David Schulsinger, and his co-authors discusses all aspects of stone disease, directed to patients with this condition and
their families.
In my 40 years in the practice of urology there is no area that has changed as
much as the management of patients with stone disease. When I began practice,
most kidney and ureteral stones were removed by open, invasive, surgical procedures requiring incisions through several layers of muscles, often with the
removal of a rib and incisions into the kidney or ureter. Patients could easily
have spent days in the hospital while recovering from these surgeries. In addition, often we could not remove all the stones requiring additional treatment!
The first change was when we discovered we could insert small tubes into the
kidney, enlarge the tract and look directly at the stone and destroy it with newly
invented forms of energy, a procedure called percutaneous lithotripsy. Then
small tubes, called ureteroscopes, were developed so we could look into the
ureter and kidney and again fragment and remove ureteral stones. Before these
advances, we would blindly insert a small tube into the ureter, open a basket,
and move the basket up and down “trolling” for the stone, when we felt the
resistance we would close the basket, pull down the tube with our fingers
crossed and hope to remove the stone! The third advance came from “thinking
out of the box” and Dr. Christian Chaussy in Munich discovered that focused
shock waves on a stone without an incision could fragment stones to small
pieces, which would pass. Extracorporeal shock wave lithotripsy was born. As
a consequence, open stone surgery is rarely needed today and “blind” basketry
is only of historical interest, all to the benefit of the patient. At the same time
we learned more about stone prevention, developed new medical drugs to prevent the recurrence of stones and finally developed drug regimens for enhancing the spontaneous passage of small ureteral stones, known as medical
expulsive treatment.
This book illustrates all aspects of stone disease from inherited factors and
personal habits, especially dietary factors, including medical treatments for
prevention of both stone formation and stone recurrences. The relevant anatomy is clearly shown, and the different types of stones described and complimented by excellent illustrations. The book continues with clear descriptions
of the various interventional forms of treatment including the pros and cons of each. The chapters are often punctuated with relevant comments from
patients who unfortunately have suffered from urological stones. Medical
management and necessary life style changes are then reviewed for patients
with different types of stones. Finally, in a unique chapter the authors give
advice as to who should treat your stone and where. Additional changes that
have taken place since I began my practice has been the development of “subspecialists.” Thus, across the country there are experts, such as Dr. Schulsinger,
who specialize in the area of stone disease. Moreover, we now know the success of various procedures with lower complications occurring in hospitals
with high volume of care for a specific problem performed by “high volume”
surgeons. Finally, although this book is primarily directed to patients and
their families, I feel it will be an excellent reference book for primary care
physicians who without a doubt will take care of patients with stone disease.
In addition, urologists will also benefit from the book, a great deal of highly
valuable informative information in one concise package