Fall 2010 - SSM Cardinal Glennon Children's Medical Center

Left: Using a video screen, Anand Palagiri, M.D., navigates through the ureter to the kidney to find Irhad Sehovid’s kidney stone. Using a laser fiber, he disintegrates the
kidney stone and pulls out the smaller pieces. Right: Dr. Palagiri directs the laser fiber to the kidney stone and blasts it apart.
It was a Monday morning at 5:00am when Irhad Sehovic, 15,
woke up with a terrible pain in his left side.
Silent Service
Pediatric Stone Center
factors is initiated. What we do now will impact these children
positively for the rest of their lives.”
10
“I tried eating something, but it wouldn’t go away,” he says.
“It was the worst pain I have ever experienced.”
When Irhad began vomiting, his parents rushed him to the
emergency room. When his vomiting persisted even after
medication, he was sent to Cardinal Glennon via ambulance.
Emergency physicians diagnosed him with a kidney stone.
Little did Irhad know he had been taken to the right place. In
2007, Cardinal Glennon launched the Midwest’s first Pediatric
Kidney Stone Center to address the painful problem that
is increasing among young children.
Kidney stones are caused by diet, dehydration or genetic
factors, which must be addressed to keep stones from reoccurring.
However, for children, once a stone has formed, they
are usually difficult to pass due to the smaller caliber of the
urinary tract. According to Dr. Palagiri, there is no stone the
Center can’t remove in any child.
“Kids have a bright future ahead of them when we deal with
and treat the stones early on,” Dr. Palagiri says. “Currently, we
offer state-of-the-art, minimally invasive techniques to remove
stones. In collaboration with Dr. Ellen Wood and her team of
nephrologists, a thorough evaluation of the etiology and risks
To treat kidney stones, Dr. Palagiri established a protocol specifically
tailored to children given the delicate nature of their
urinary tract. It usually follows these steps and requires up to
three separate procedures:
1. Placement of a ureteral stent: The stent protects the
kidney and ureter and alleviates the obstruction caused
by the stone. At the same time, it dilates the ureter prior
to the second procedure.
2. Procedures:
• Holmium Laser: Using a tiny camera and a scope,
Dr. Palagiri inserts a small laser fiber that targets
and breaks apart the stone so it can be removed in
multiple pieces.
• Extracorporeal Shock Wave Lithotripsy (ESWL):
If the stone is in the kidney and can be seen on
diagnostic x-ray, the Center may elect to use sound
waves to target the stone. The stone is pulverized
into sand and is much easier to pass. This option
requires no invasion of the body.
3. Stent Removal: When a stone requires manipulation to
be removed, often times the ureter can swell shut after
the intervention. In these cases, Dr. Palagiri will leave a
stent behind to protect the ureter. He then removes it