"Many of my patients have described a kidney stone as one of the most painful things they have ever experienced, even if their stone is quite small,” he says. "With difficulty urinating and possibly blood in the urine, the excruciating pain caused by kidney stones often prompts a visit to the emergency room."
But for people with kidney stones in Brooklyn, there are many treatment options at NYU Lutheran. First, Dr. Gulmi says, it is critically important to determine the stone’s size, shape, and location within the urinary tract, so that physicians can determine the best treatment approach. Although more commonly seen in adults, Dr. Gulmi adds that kidney stones in children have been increasing.
"Medication and noninvasive efforts to flush out the stone are the first course of action to consider,” Dr. Gulmi says. “If this is not successful, or if stones are too large to pass on their own, we offer other minimally invasive approaches that can be very effective.”
These include extracorporeal shock wave lithotripsy (ESWL) using high-energy sound waves to crush the stones; ureteroscopy, which involves coursing the thinnest of scopes through the ureter to grab or pulverize the stone using a laser; and percutaneous nephrolithotripsy, a technique using a thin needle to gain access to larger kidney stones. When congenital defects accompany the kidney stones, robot-assisted surgery can be performed to treat the anatomic defect and remove the stone at the same time.
"Urologists were among the first group of specialists to welcome the use of robots in the operating room,” Dr. Gulmi says. “The three-dimensional view, high magnification, precision, and dexterity provided by robots enable surgeons to perform delicate surgery that preserve and minimize damage to tissues."
Some people have the mistaken belief that avoiding calcium-rich food can prevent kidney stones. In fact, according to Dr. Gulmi, some types of calcium can bind with other nutrients—and actually prevent or help break up kidney stones.
Sometimes confused with gallstones, kidney stones are formed often from an accumulation of calcium or uric acid in the urine, a byproduct of the kidneys' role as the body's filters of waste and extra fluid from the bloodstream. Diet, inadequate fluid intake, extreme sweating from heat or exercise, and weight loss surgery, among many other diseases, can cause kidney stones to form. After kidney stone surgery, a metabolic evaluation is recommended, which takes into consideration the type of stone the patient had so that steps can be taken to prevent a recurrence. "Recurring kidney stones can pave the way for chronic kidney disease," says Dr. Gulmi.
Before coming to NYU Lutheran, Dr. Gulmi served as chairman and residency program director of the Department of Urology at Brookdale Hospital Medical Center, where he worked for 31 years. Over the course of his distinguished career, he has seen the specialty of urology undergo monumental changes. "The challenge of diagnosing and treating urologic diseases, including kidney stones, cancer of the urinary system, including bladder and prostate cancer, have benefited from advances in clinical research as well as in technological innovations," says Dr. Gulmi. "At NYU Lutheran, we have the expertise and technology that can achieve the most optimal urologic surgical outcome for our patients."