Radiation-Free Pediatric Kidney Stone Treatment

Generally speaking, the way doctors approach kidney stone removal depends on factors such as the stone’s size, location and composition. Historically, age has not been one of these factors.

Heiko Yang, MD, PhD, is changing that.

“Typically, with kidney stones in children, most people use X-rays to help with the procedure and get the instruments in place,” Dr. Yang explains. “In adults, using X-rays is not a big deal because adults are much less sensitive to X-rays and radiation.” But the effects of radiation are more severe in children, and with an increase in pediatric kidney stones, it’s important to expand the options for removal.

His approach considers the amount of radiation children receive in the process, and his goal is to develop a way to remove these stones without using X-rays at all.

A safer approach to removing kidney stones

If you have a question about Dr. Yang’s approach, chances are he’s answered it.

“Is it safe?” “Is it as effective?” “Is it going to take longer?”

“From my experience in adult kidney stone surgery, where I’m already doing a lot of radiation-free surgery, I wanted to prove that, yes we can do it in children and achieve good results.”

Over the last year, Dr. Yang has helped more than 30 people with kidney stones through radiation-free kidney stone removal. Of those cases, only two needed additional X-ray therapy due to their complex anatomy.

All other cases were completed safely and successfully without any use of X-ray.

The dangers of using of X-ray

X-rays are an efficient, noninvasive tool used to treat kidney stones in the medical space. However, they aren’t always a necessary first line of treatment and can carry some risk.

X-rays use ionizing radiation that can damage DNA and increase the risk of cancer. Children are more vulnerable to the harms of radiation due to their developing bodies and susceptible cell movement. When used appropriately, in moderation and on fully developed adult bodies, these risks are limited.

How does radiation-free kidney procedure work?

Dr. Yang’s process is minimally invasive. He uses ultrasound, which provides a clear visual, to guide a scope through the urinary tract and access the kidney directly. This process relies on visual and tactical feedback rather than X-rays.

From there, a very thin telescope is placed into the bladder, travels up the kidney and locates the stone. “Then you (use lithotripsy, or shock waves) to zap it, and you take it out,” Dr. Yang explains.

In the traditional method, X-rays are used to help put the instruments in place. But Dr. Yang never saw that as a necessary step, especially in pediatric cases. “When I put the scope up from below, I’m visualizing the landmarks the entire time. I’ve always felt that if you can see everything with the scope, why would you need an X-ray?”

Of course, radiation-free is not always an option. There are complex situations where visualization isn’t of a high enough quality and for enhanced safety, X-rays are necessary.

Inspiring a radiation-free future

Though Dr. Yang’s radiation-free approach is safer and just as effective, other clinicians have been slow to adopt it, often preferring the approach they learned in training. That’s why Dr. Yang is sharing his perspective and experience broadly. “We’re fortunate to have a teaching hospital here, so I’m able to share my discoveries with my residents and teach them how to do this safely and effectively,” Dr. Yang says.

Currently, Dr. Yang is one of very few attending surgeons performing this radiation-free surgery for kidney stone removal. However, he has a number of trainees working closely with him. Once they gain more experience, he hopes they will adopt similar methods.

Growing awareness for radiation free surgery

From Dr. Yang’s experience, kidney stones have been a wildly overlooked disease in the pediatric space, mostly because the condition isn’t on most pediatric urologists’ radars due to the fact that kidney stones are more prominent in adults. Still, Dr. Yang feels the problem is becoming increasingly important for doctors to attend to in children. “I’d like families to know that, there is someone who is primarily interested in this and is trying to make it better in the pediatric space — especially for a diagnosis that’s becoming more and more common in children,” he says.