ROBERT SALANT, MD: We go in through the urethra using a very thin telescope which is directed up to the level of the stone. Then under direct vision, the stone is then broken up using one of the energy sources.
PAUL MONIZ: Just for our audience, the urethra is?
ROBERT SALANT, MD: The urethra is the tube where the urine comes out from the bladder. So in the male, it's through the penis, and in the female, it's just above the level of the vagina.
PAUL MONIZ: If that doesn't work, Dr. Marks, what happens next?
JON MARKS, MD: For stones that are large that reside in the kidney, these are not appropriate to be treated with shockwave lithotripsy.
PAUL MONIZ: Like this one here. If a patient came in and had this particular size.
JON MARKS, MD: This would not be appropriate to treat with shockwave lithotripsy. In years gone by, we would have done an open operation. But now we can do what's known as percutaneous nephro-lithotripsy, not to be confused with shockwave lithotripsy. That's a procedure whereby we make a small hole in the patient's back. We insert other kinds of telescopes directly into the stone under radiographic guidance using fluoroscopy. We apply various energy sources to the stone to break it up, and we physically remove large chunks of the stone through this small hole that we made in the patient's back.
PAUL MONIZ: If you have to split the kidney, as it were, in the most extreme case, there are some complications involved. Potentially.