Shattered Masses

Kidney stones obliterated using sound wave technology.

On a pleasant afternoon in early November, Luz Jimenez was enjoying a fun fall adventure at Walt Disney World®. She was hosting family members visiting from her native Colombia. Suddenly, she was hit with excruciating pain. It was so severe, it forced the 58-year-old mother of three to rush to the nearest hospital.

Dr. Alejandro Miranda-Sousa treated Luz Jimenez for a kidney stone using extracorporeal shock wave lithotripsy (ESWL). Dr. Miranda-Sousa’s practice, Urology Experts, has offices in Fort Myers, Cape Coral and Bonita Springs.

ESWL resolved Luz’s painful kidney problem without surgery.

“I was in the park when I started to feel the pain,” Luz confirms. “It was terrible. I had to leave and go to the emergency room. The doctor there told me I had a large kidney stone. I have a long history of kidney stones, but this one was big.

“I didn’t want to stay in Orlando because my urologist, Dr. Miranda-Sousa, was in Cape Coral, where I live. The doctor gave me something for the pain, and I went home. Right away, I made an appointment to see Dr. Miranda-Sousa.”

Luz’s physician is board-certified urologist Alejandro Miranda-Sousa, MD, of Urology Experts. Because of her history of kidney stones, Luz needs to be followed carefully by a urologist. She discovered Dr. Miranda-Sousa after going online to look for urologists in the area. To her,
Dr. Miranda-Sousa stood out from the crowd. 

“I had a urologist in Miami, where we lived for thirty-two years,” Luz relates. “Two years ago, we moved to Cape Coral, and I started looking for a doctor here. I searched the internet, and found Dr. Miranda-Sousa. I’m so happy I did because he’s a good doctor.”

During Luz’s appointment at Urology Experts, Dr. Miranda-Sousa performed a complete evaluation of her condition. He also ordered an x-ray to confirm the presence and location of her stone.

“When Luz came to see me, she was in severe pain,” Dr. Miranda-Sousa notes. “She had a stone in her ureter that was blocking urine drainage from the kidney into the bladder. We discussed the need to break up the stone and unblock the kidney. I told her there was a nonsurgical procedure that does this that is safe and effective.

“The procedure is a newer, noninvasive technique that breaks up stones very nicely and minimizes side effects, as well as potential injury to adjacent organs. It’s called extracorporeal shock wave lithotripsy, or ESWL. The technology has been around for years, but the method of delivering the treatment has recently been advanced.”

“In the past, Dr. Miranda-Sousa worked to resolve my kidney stone problem conservatively,” Luz recounts. “Now, he was going to try the new therapy. I agreed because I was in the worst pain I’ve ever felt. My kidney had been blocked for four days, and that made me very uncomfortable.”

Rolling Stones

Kidney stones are very common. In the United States, stones affect an estimated one in every 500 people. One in eight men and one in 16 women will develop a stone at some point in their lives.

“There are many symptoms associated with stones in the urinary tract,” Dr. Miranda-Sousa alerts. “These include severe pain in the back and side that radiates into the lower abdomen, pain that comes in waves, dark or red urine, needing to urinate often but urinating only small amounts, bad-smelling urine, and fever and chills if there’s an infection.”

Generally, stones are discovered when patients go to the emergency room with pain that then goes away. Most patients who have one episode of pain will have another. It’s best to treat those stones before they cause an acute condition that can be trickier to treat.

“Sometimes, patients have little stones they pass,” Dr. Miranda-Sousa reports. “These patients need to take steps to prevent an attack of pain from happening again. They can start by drinking more fluids to reduce their risk of getting new stones or prevent any small stones they already have from getting larger.

“Some stones cause trouble and some don’t. When they cause trouble, it’s often an acute episode that needs intervention. Treatment of stones can be invasive or noninvasive. The choice depends on certain factors.”

To determine an appropriate approach to treatment, Dr. Miranda-Sousa evaluates the location and size of the stone, any medical issues the patient has and how acute the condition is, including whether or not there’s an infection.

Revolutionary Approach

When ESWL was first introduced in the early 1980s, it revolutionized the treatment of kidney stones. Using ESWL, patients who in the past required major surgery to remove their stones could be treated effectively with a noninvasive approach that didn’t require a single incision.

“With ESWL, we don’t have to cut into the body,” Dr. Miranda-Sousa verifies. “Instead, it uses high-energy sound waves applied from the outside to break up stones into very small pieces that are easily passed by the patient through urination.

“The success rate with this approach is usually very good. In about eighty-five to ninety percent of cases, stones break up and clear without any invasive procedures required.”

During modern ESWL, patients are put to sleep with general anesthesia or are heavily sedated, and a local anesthetic is used. Patients are taken to an operating room where they lie on a special stretcher that has the lithotripsy machine, or
lithotripter, attached. The lithotripter works through an area approximately one inch in size, and it delivers its sound waves through that area.

“When we treat patients, we move the stretcher up, down, left, right, forward and backward,” Dr. Miranda-Sousa describes. “We move the patients so that the location of their stones aligns with the sphere through which treatment is delivered. We use x-ray to constantly know the location of the stones we are treating.”

Dr. Miranda-Sousa uses a standard number of shocks during an ESWL treatment. This amount has been proven to be safe and effective for patients. The procedure takes 45 minutes to an hour to perform.

“Once the patient’s stones are broken up, the very small fragments pass anywhere from two days to six weeks following the procedure, depending on how many small fragments there are,”
Dr. Miranda-Sousa reports. “The more there are, the longer it takes.

“ESWL is an outpatient procedure. Patients generally go home the same day. Following the procedure, patients are asked to take it easy for twenty-four hours, but most return to work and
activities the day after that.”

Kidney stones often recur, however. Fifty percent of the time, they come back within five years. ESWL can be performed again if stones recur.

“I understood the concept behind the procedure because I’ve had lithotripsy before,” Luz states. “But I never had it done this new way. ESWL resolved my kidney stone problem because it broke up the big stone and moved some little ones.

“I feel so good now. ESWL is the best procedure to have. I recommend it to anyone with kidney stones.”

Luz is happy to recommend Dr. Miranda-Sousa and his staff at Urology Experts as well. Because of their expertise and quality patient care, Luz says she has an excellent experience whenever she visits the practice.

“Dr. Miranda-Sousa is the best doctor,” she says. “Every time I’m there, he shows real interest in me. The staff is so friendly and nice. I feel lucky because I found them. I’m also very grateful for them because I feel so much better now.”

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    • Urology Experts

      The team at Urology Experts is dedicated to providing exceptional healthcare and personalized treatment plans. They offer a number of different urological services and specialties that will help any patient restore their quality of life.... Read More

    • Alejandro Miranda-Sousa, MD

      Alejandro Miranda-Sousa, MD, is a board-certified urologist by the American Board of Urology. Dr. Miranda-Sousa graduated from the prestigious Universidad Peruana Cayetano Heredia School of Medicine in Lima, Peru. He also completed his r... Read More