Ensuring Individualized Treatment Plans for Each Patient

The Stone Center at Cincinnati Children’s is leading the way in treating kidney stones in children by bringing together several specialists to provide comprehensive care. This ensures each patient receives holistic care tailored to their unique needs.

The Stone Center’s team, led by co-directors William DeFoor Jr., MD, MPH, and Eugene Minevich, MD, prioritizes coordinating efforts across various specialties to address the complexities of kidney stone treatment in children.

The center’s primary focus is preventing kidney stones and reducing their recurrence. As DeFoor emphasizes, “The goal of our research over the last two decades has been prevention.”

Since its establishment in 2014, The Stone Center’s multidisciplinary approach has led to significant improvements in patient outcomes, reducing surgical interventions and emergency department visits. Surgical procedures declined from 40% to 18% within a year of initial treatment, while emergency department visits decreased from an average of 1.5 to 0.5 per year.

Other significant advancements include identifying dietary factors contributing to stone formation in patients with feeding tubes and developing new dietary guidelines to prevent stones.

The Stone Center’s hybrid operating room accommodates various procedures, from minimally invasive to open surgery, all in one location. The team uses the latest technologies, including laser and shock pulse lithotripsy, to treat even the most complex kidney stones. The Stone Center also actively participates in the Image Gently® campaign to minimize children’s exposure to ionizing radiation.

“We have all the latest instruments for treating stones. We never have to refer patients out for any kind of surgical management,” DeFoor says.

Comprehensive Care: Our Collaborative Approach

The center has assembled a team of experts, including a dedicated pediatric nurse coordinator and strong affiliations with genetics, emergency medicine, gastroenterology and neurology.

A crucial component of the Stone Center’s success is its collaboration with the nephrology department. DeFoor explains, “We work together in both the surgical and medical management of kidney stones in children.” By combining the expertise of urologists and nephrologists, the team can evaluate patients for metabolic abnormalities, develop effective management plans and provide holistic treatment.

Minevich states, “Nephrologists evaluate every child with kidney stones and usually involve geneticists and other specialists as needed.”

He adds, “Nephrology and urology are the driving forces behind the whole idea of the Stone Center. We see patients together, developing plans, discussing them and following them, at least initially.”

Conditions Managed by the Stone Center Team

Stone disease in children has seen a four-fold increase since 2003. And about 30–50% of children with a kidney stone will develop a new stone within five years. “We treat children with kidney stones, and some of them are what we call ‘one and done,’ meaning they just have one kidney stone. Then there are the recurrent stone formers or kids with congenital chronic medical conditions that put them at risk of kidney stones,” says DeFoor.

Chronic conditions that increase the risk of kidney stones include:

• Neurogenic bladder
• Recurrent urinary tract infections
• Voiding dysfunction
• Non-ambulatory status
• Severe developmental disorders, such as difficulty communicating symptoms

Expanding Expertise and Services

In response to the growing demand for kidney stone treatments, the Stone Center has expanded. Additions to the team include nephrologist Tim Caldwell, MD, PhD, and medical director Prasad Devarajan, MD.

The center has also grown its reach from the Burnet Campus to neighborhood locations, ensuring more patients can access specialized services.

“We strive to offer comprehensive care and ensure that every child receives the best possible treatment through our collaborative and multidisciplinary efforts,” Minevich says.

(Published October 2024)

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