Treating the Hardest Kidney Stones

The Indian Institute of Kidney Disease and Research Center Uses State-of-the-Art Lithotripters to Treat Kidney Stones

November 04, 2014 | Ahmedabad in India has among the world’s highest number of urologists, and their patients have extremely tough kidney stones. State-of-the-art lithotripters are an effective and affordable way to treat these patients.


Text: Saritha Rai
Photos: Thomas Steuer


Management Summary

India’s dry northwest region has a population highly prone to kidney stones. Untreated kidney stones can lead to kidney failure. It is a healthcare burden that weighs on families, also in terms of costs.

Accurate diagnosis and timely minimally-invasive lithotripsy procedures at the Institute of Kidney Disease & Research Centre break up the kidney stones with minimal side effects.

Over 3,000 patients have been treated so far with minimal side effects. The success rate: 90 percent

Heading the Institute of Kidney Disease & Research Centre (IKDRC) is urologist Dr. Pranjal Modi, who oversees treatments using the lithotripsy system on a stream of patients from the city and its neighboring towns and villages. Currently, up to half-a-dozen kidney stone patients are treated per day, six days a week, at the center. “It is an area predisposed to kidney stones,” says Dr. Modi, due to the rush from the arid expanse that stretches across India’s northwest.


The Importance of Treatment
Left undiagnosed or untreated, kidney stones can lead to kidney failure, a healthcare burden for the patient as well as an economic burden that many Indian families simply cannot afford. The problem is grave, says Dr. Modi, a transplant surgeon and leading global expert on robotic renal transplants. Despite the widespread incidence of kidney stone, Ahmedabad, one of India’s most affluent cities, has very few electromagnetic lithotripsy systems. With its two electromagnetic lithotripsy systems, IKDRC has treated over 3,000 patients so far. The stones prevalent in the region are the difficult-to-treat variety made up of hard calcium oxalate. “Compared with the type commonly found in European or American patients, these are difficult to break,” Dr. Modi says. This is where the Siemens lithotripter comes in, with its technology to disintegrate hard stones easily.


Financing of public hospitals in India

The Institute of Kidney Disease and Research Center (IKDRC) is run by a trust, which works to make treatments accessible to patients. In typical government hospitals, budgetary decisions (about which equipment to buy, how much to spend on a building, etc.) are taken by health department officials. This hospital is different as it is run by a non-profit trust and yet funded by the government. The doctors, actual practitioners, make the decisions. The capital investment for the system came from the government. Its operation and maintenance costs are covered by the fee charged to paying patients. The system’s efficiency as well as the doctors’ modest, fixed, government-grade pay makes treatments affordable.

The Patient Rush
The Institute’s first Siemens lithotripter was installed in 2010, after its experts studied and compared its technology with other systems. Patients from the region and the neighboring Rajasthan and Madhya Pradesh states, too, started arriving. The government-funded center’s quick decision helped the speedy installation of a second system in 2012 to meet the patient rush.

Success Rate of 90 Percent
Patient safety is paramount explains Dr. Modi. As the stones are tough, a large number of high-energy shock waves are administered to the patient. Imprecise treatment leads to damaged kidneys. The Siemens lithotripter’s advanced technology can deliver high-energy shock waves to a large focal area. Variation is measured, treatment time is recorded, and the amount of energy given is documented. Safety norms are stringently followed to minimize side effects. Patients receive between 60 and 90 shock waves per minute so as to not damage the kidneys. “If we slowly build up the energy levels, we have better control and renal hematoma is reduced,” says Dr. Modi, whose sensibility as a renal transplant surgeon plays a big role at the center. Renal hematoma occurred in 0.7 percent of patients who underwent lithotripsy. Side effects, Dr. Modi confirms, are minimal. The stone clearance success rate is very high at over 90 percent after the first treatment.


About the Author

Saritha Rai is an India-based journalist. Rai has a degree in journalism from Bangalore University and was a Knight Fellow at Stanford University. She currently is a Contributing Editor at Forbes Asia and a Contributing Editor at the leading Indian newspaper, Indian Express.

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The statements by Siemens’ customers described herein are based on results that were achieved in the customer's unique setting. Since there is no "typical" hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results.