How to Build a Kidney Stone Prevention Clinic

Those identical, ethical mandates were told to me on two occasions: first, when as a preteen I objected to my father, a dentist, fluoridating the teeth of his young patients, suggesting that he was sacrificing his income (and my future college tuition) by the prevention of caries; second, when as a proto-lithologist, Michael Grasso and I discussed the founding of a kidney stone clinic and I asked Michael if he was worried that I would reduce the number of ureteroscopies and lithotripsies he would perform. Kidney stones are common and preventable, but not commonly prevented. Instead, our experience has been that most patients, despite their interest, have not received any serious recommendations about how to avoid kidney stone recurrence. Stone formers seek advice regarding their disorder, whether that is about the choices for urological intervention or strategies and regimens for prevention. Bringing these two components of kidney stone practice together into a single setting is the goal of a kidney stone clinic. Like any other disorder, expertise among practitioners develops with exposure and repetition. A kidney stone clinic offers these assets to its personnel while offering patients the confidence that develops when expertise is demonstrated. Simply titling one’s office or practice a “kidney stone clinic” may lead to some assurance that the disorder is seen repeatedly there, but developing a real integration of diverse skills and mastery will be even more convincing. This book arises from the partnership that Michael Grasso and I began in 1996 when we first formed a kidney stone clinic. Michael brought his vast experience in endourology and urological intervention for kidney stones to our enterprise. My contribution, as a nephrologist and physiologist, was