Slate's Medical Examiner: New Cure for Kidney Stones

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If you suffer from kidney stones, you know how painful it can be — and the treatment isn't too pleasant, either. But there may be an alternative. Madeleine Brand speaks with Slate medical columnist Dr. Sydney Spiesel about a new medication that helps get rid of kidney stones.

MADELEINE BRAND, host:

From NPR News' DAY TO DAY with our weekly medical segment. And brace yourself for this topic: kidney stones. They are painful and dangerous, especially when they travel to the urinary tract. But there's a new method of getting rid of them and Dr. Sydney Spiesel is here to tell us about it.

Syd is a professor at the Yale Medical School and he writes the Medical Examiner column for the online magazine Slate. And he joins us each week to talk about medical problems. Hi, Syd.

Dr. SYDNEY SPIESEL (Yale Medical School):

Hi, Madeleine.

BRAND: Well, first of all, tell us what exactly are kidney stones.

Dr. SPIESEL: Well, kidney stones are actually physically little hard objects. They really are stones, and if you remember high school chemistry, when you had a solution of something and it became too saturated so that the stuff wouldn't remain solution, it would precipitate out and crystals would form. And that's what happens inside the kidneys, and then they travel down through the ureters, the tubes that connect the kidneys to the bladder, and then sometimes they wind up in the bladder. And very often, probably 50 percent of the time, ultimately they're lost in the urine when people urinate.

BRAND: And for those that aren't, what do people usually do to get rid of them?

Dr. SPIESEL: One method involves sending these tiny little endoscopes, these little flexible telescopes, up through the urethra, through the bladder, into the ureter and find the stone and grab it or find the stone and crush it into tiny stones that can be released in the urine. That's one method.

Another method is to send, this sounds horrible, but it actually is pretty effective, to send a shock wave, to put somebody in a vat of water or something like that and send focused shock waves that are concentrated on the place that the stone is, through the body wall, which is sort of flexible and transmits the shock, and all these shock waves concentrate and the stones are literally exploded.

BRAND: Wow. Well, both of those methods sound, perhaps, even more painful than the kidney stones themselves. So you said there's a new, non-invasive method out, so that must be of great relief to patients with kidney stones.

Dr. SPIESEL: Well, I think it is. Although, it only applies to stones that have been released by the kidney and have passed down through the ureter and in fact are in part of the ureter which is nearest the bladder.

This is based on the idea that a kidney stone is kind of an irritating, annoying thing, and the walls of the ureters, these tubes, are full of muscle, and that if they get irritated, they can contract tightly and hold the stone in place.

And so a urologist named Marco Dellabello(ph) working in Kona(ph), Italy, devised this method of administering a medication that attaches itself to the muscles that are present in the walls of the ureter and cause it to relax. And as these muscles relax, the stone is released and the people just pass it out.

And the results have just been remarkable. Of 70 people treated experimentally with this drug, the trade name is Flomax, none in the hospital, all of them at home, 68 people expelled their stones.

BRAND: So does it look like this muscle relaxant will replace all those other treatments?

Dr. SPIESEL: Well, I sort of thought it would. I'm not sure how widely people know about this now. As I say, one problem is that this came from an Italian study, and there's a kind of chauvinism that happens in medicine. It's not exclusive, but sometimes I have the sense that medications or ideas that came from someplace else are not treated quite as respectfully.

BRAND: Dr. Sydney Spiesel of the Yale Medical School. You can read his columns at Slate.com. Thank you, Syd, again.

Dr. SPIESEL: Thank you.

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