Cleveland Clinic Stone Center

Cleveland Clinic Stone Center

Endourology

Seven endourology specialists support Cleveland Clinic's Stone Center, covering four hospitals where major endourological procedures are performed: main, Hillcrest Hospital, Avon Hospital, and, starting in 2023, Akron General. Associated urologists in Fairview, Strongsville, and Twinsburg complement with the treatment of urgent stone cases.

A total of 9224 patients with stone diseases were seen by the endourology team in 2022.

Minimally invasive stone surgeries performed by Cleveland Clinic Stone Center specialists have increased dramatically in recent years. The total of endourological cases increased from 600 in 2016 to 1592 in 2022, as did the two main endoscopic surgeries to treat stones.

  • Ureteroscopy with stone removal increased from 318 cases in 2016 to 1166 in 2022.
  • Percutaneous nephrolithotomy increased from 282 cases in 2016 to 426 in 2022.

The total number of stone cases for 2023 is estimated to further increase by more than 15%.

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Endoscopic Surgical Procedures

Volume growth 2016-2022

Instrumentation such as thulium laser technology, endoscopes for ureteral and kidney surgery, and new video systems guarantee that all types of stones can be treated, regardless of composition or complexity. These newer surgical techniques favor less-invasive procedures with decreased complication rates and improved outcomes.

  • Transfusion rate has decreased from 4% to less than 1%.
  • Percutaneous nephrolithotomy is now performed in most cases using a mini-percutaneous access (only 5mm tract required) to the kidney, which decreases significantly the risk of bleeding, need for transfusion, and postoperative pain.
  • For medium-sized stones, the mini-percutaneous nephrolithotomy has better stone-free outcomes, compared with other endoscopic treatments.¹ This less-invasive percutaneous approach also allows most patients to go home on the same day.²

Carepath Guides have been reviewed following strict parameters of the American Urological Association, the European Association of Urology, and other international panels on stone diseases guidelines. The list of updated guidelines from the Stone Center includes

  • prevention and management of infectious process during endoscopic surgery for kidney stone
  • perioperative antimicrobial selection before endoscopic procedures for kidney stones
  • management of stones in the Emergency Department
  • management of acute urinary obstruction secondary to kidney stones in pregnant women
References
  1. Dutta R, Mithal P, Klein I, Patel M, Gutierrez-Aceves J. Outcomes and cost following mini-percutaneous nephrolithotomy or flexible ureteroscopic lithotripsy for 1-2 cm renal stones: Data from a prospective, randomized clinical trial. J. Urol. 2023;209:1151-1158.
  2. Thakker PU, Mithal P, Dutta R, Carreno G, Gutierrez-Aceves J. Comparative outcomes and cost of ambulatory PCNL in select kidney stone patients. Urolithiasis. 2023;51(22). https://doi.org/10.1007/s00240-022-01392-5.