After a failed kidney stone procedure left Anna Smith with only one kidney, she found kidney stone experts she could trust at Duke Health. When she needed large stones removed, Smith traveled far and wide -- even from Hawaii -- to see Duke urologists. “I flew over many major medical centers to make my way to Duke,” said Smith. “I wouldn’t dream of going anywhere else.”
A Life-Changing Diagnosis
Smith was in her early 20s when she discovered she had cystinuria, a rare genetic condition that causes kidney stones. When a scan showed she had several large kidney stones, Smith underwent a standard procedure in her hometown in Mississippi. It didn’t go well and ended with the removal of one of her kidneys. “It was very upsetting,” said Smith.
Finding Kidney Stone Experts at Duke
Years later, Smith was living in Hawaii when she experienced an obstruction in her ureter that stopped the flow of urine. She was life-flighted to a hospital in Honolulu where doctors inserted a small, temporary, plastic tube called a stent into her ureter, then sent her home pending further treatment.
Unsettled by the situation, Smith’s father, a family physician, urged her to seek immediate care. “He called colleagues and asked for the best kidney stone specialists and was referred to Duke,” she said. Smith flew from Hawaii to Duke where she underwent a lithotripsy procedure, which broke up the kidney stone into smaller, dust-like pieces that she could pass through her urine.
More Kidney Stones Decades Later
Smith went more than two decades without any complications. She moved to Asheville and had regular checkups until one day her bloodwork indicated she had decreased kidney function. “I thought I must have a stone, so I requested an ultrasound,” she explained. Smith was right. Imaging showed she had a large stone in her kidney, which had probably been growing for years. When her doctor referred her to a local urologist, Smith told him she was going to Duke.
Back to Duke for Another Kidney Stone Procedure
Smith met with Duke Health urologist Robert Medairos, MD, who talked to her about two options:
- Percutaneous nephrolithotomy (PCNL): A small incision is made in the skin, through which a tube is inserted into the kidney to break up and suction out the stones.
- Ureteroscopy: A small, flexible scope is inserted through the ureter to reach the kidney. Using a laser, the stones are broken into small pieces and dust.
“The way they presented me with options made me feel like it was a true partnership,” Smith said.
Smith wanted the PCNL surgery as soon as possible so she scheduled it with Duke Health urologist Jodi Antonelli, MD. “Anna really got to experience our team-based approach to stone care,” said Dr. Antonelli.
Going with Plan B
In August 2024, Dr. Antonelli attempted the PCNL procedure on Smith, but quickly realized it was not the safest option. “Her kidney anatomy was very delicate,” explained Dr. Antonelli. “I didn't want to continue with this more invasive approach given the fact that she ended up losing her kidney when somebody else tried 20 years ago.” Instead, Dr. Antonelli placed a stent in Smith’s ureter in preparation for a ureteroscopy weeks later.
Dr. Antonelli performed the ureteroscopy using new technology developed with the help of Duke Health urologist Glenn M. Preminger, MD. The Continuous Vacuum and Irrigation System (CVAC) is a ureteroscope that can be passed from the bladder up to the kidney and enables suction of stone dust and fragments generated by a laser rather than leaving them to pass through the urine. “The use of suction in ureteroscopy is a game changer,” said Dr. Antonelli. “It meant I could do the less invasive option but still get the benefits of taking out the fragments.”
Stone-Free Almost a Year Later
Nearly a year later, Smith is kidney-stone-free. She’s grateful to the kidney stone specialists at Duke and is happy to be closer to the kidney stone doctors she trusts. “My experience has always been fantastic,” said Smith. “I’m so thankful to Duke.”
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Kidney Stones
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