Georgia Sits Inside America’s Kidney Stone Belt. Here’s How Treatment Has Transformed: Dr. Jitesh Patel on the Science of Modern Stone Care

Kidney stones are among the most common reasons Americans land in the emergency room. A board-certified urologist explains how finding, removing, and preventing them became a far more precise science.

The pain of a kidney stone is one of the oldest complaints in medicine, described in texts thousands of years old and still ranked by many patients among the worst they have felt. What has changed is not the pain. It is how precisely urologists can now locate a stone, remove it, and keep the next one from forming.

Dr. Jitesh Patel, the board-certified urologist who founded and leads Advanced Urology in metro Atlanta, trained in exactly this work. He earned his medical degree at Temple University School of Medicine and completed a six-year surgical residency at Thomas Jefferson University Hospitals, where he served as chief resident with advanced training in stone disease and endourology, the branch of urology built around treating the urinary tract through its own natural channels rather than through open surgery. Over two decades in practice, he has watched stone care shift from a blunt, painful ordeal into a set of targeted, mostly incision-free procedures.

A condition the Southeast knows well

Kidney stones are common and getting more so. Roughly 11 percent of men and 7 percent of women in the United States will form one in their lifetime, according to the NIH reference Endotext, and recent national survey data found that nearly 10 percent of adults report a history of stones. Acute stone passage is one of the leading reasons people visit an emergency room.

Geography plays a real role. Stones are markedly more common across the Southeast, a band of states urologists refer to as the stone belt, with Georgia sitting squarely inside it. The leading explanation is climate: heat drives fluid loss through sweat, which concentrates the urine and makes it easier for crystals to form. For a practice based in metro Atlanta, that means stone disease is not an occasional problem but a steady part of the daily caseload.

The other defining feature of stone disease is that it comes back. Without treatment aimed at the underlying cause, roughly half of patients form another stone within ten years. That single fact, more than any procedure, shapes how a thoughtful urologist approaches the condition.

The first question is what the stone is made of

To a patient in pain, a stone is a stone. To a urologist, the composition is the whole story. Most stones are calcium oxalate, but others form from uric acid, from infection, or from inherited metabolic disorders, and each type points to a different cause and a different prevention strategy. Sending a passed or removed stone for analysis is the starting point, not an afterthought.

From there, the workup looks past the stone to the chemistry that produced it. Guidelines from the Agency for Healthcare Research and Quality describe a metabolic evaluation that can include blood tests and a 24-hour urine collection measuring volume, calcium, oxalate, citrate, uric acid, and acidity. Those numbers reveal why a particular patient forms stones, whether the driver is too little fluid, too much dietary salt, low urinary citrate, or a metabolic condition that needs its own treatment.

“Most patients want the stone gone, and we can do that. But if we stop there, a lot of them are back in two or three years. The stone is a clue. Analyzing what it is made of and studying the urine that produced it tells us why this patient forms stones, and that is what lets us actually prevent the next one.”—DR. JITESH PATEL, FOUNDER AND PRESIDENT, ADVANCED UROLOGY

Three ways to remove a stone, and the logic for choosing

When a stone needs to come out, modern urology offers three main approaches, each suited to different stones. They sound similar at a distance but work in very different ways:

• Shockwave lithotripsy (SWL) focuses acoustic shockwaves from outside the body to break a stone into fragments small enough to pass on their own. It requires no scope and no incision, which makes it appealing, though it is less effective for larger or denser stones.
• Ureteroscopy with laser lithotripsy threads a thin, flexible scope up through the urinary tract to the stone, where a laser breaks it apart. The fragments are then removed or left small enough to pass. It reaches stones throughout the ureter and kidney without an incision.
• Percutaneous nephrolithotomy (PCNL) is reserved for very large or staghorn stones. Through a small incision in the back, the surgeon passes an instrument directly into the kidney to remove the stone, as the National Kidney Foundation describes it. It is the most involved option and the most effective for the biggest stones.

The choice among them is driven by size and location, and the 2026 AUA guideline on the surgical management of stones lays out the logic in detail. For small stones low in the kidney, shockwave lithotripsy, ureteroscopy, or a percutaneous approach can all be reasonable. For stones larger than a centimeter in the lower pole, the guideline notes that percutaneous nephrolithotomy clears them more reliably than the alternatives, and that shockwave therapy should not be the first choice for large stones at all. Across the board, ureteroscopy now achieves higher stone-free rates than shockwave lithotripsy, which is part of why it has become the workhorse of the field. For small stones already moving down the ureter, a 30-day course of an alpha-blocker such as tamsulosin can help the stone pass without any procedure.

The technology that made ureteroscopy the workhorse

The rise of ureteroscopy is a story of incremental engineering. Flexible scopes, including single-use models that arrive sterile and eliminate the risk of carryover infection, now bend to reach nearly every part of the kidney. Ureteral access sheaths, some with built-in suction, improve visibility and help clear fragments. And the lasers have advanced: as coverage of the 2026 guideline notes, surgeons can use a holmium:YAG or a newer thulium fiber laser either to fragment a stone into pieces that are basketed out, or to reduce it to fine dust. Each refinement has pushed more stone treatment out of the hospital and into shorter, lower-risk outpatient procedures.

“There is no single best way to treat every stone. A small stone low in the kidney, a large stone packed into the collecting system, and a stone lodged in the ureter are three different problems, and the size, location, and hardness all change the answer. The advances in flexible scopes and lasers mean we can reach almost anywhere in the kidney through the body’s own channels, often without a single incision. The skill is in choosing the right approach, not in owning the newest device.”—DR. JITESH PATEL, FOUNDER AND PRESIDENT, ADVANCED UROLOGY

The part of stone care patients tend to skip

Removing a stone solves today’s problem. Preventing the next one solves the disease. Given a recurrence rate near 50 percent over a decade, prevention is where stone care either succeeds or quietly fails, and it depends on the metabolic picture the workup produced. Higher fluid intake remains a foundation, alongside targeted dietary changes and, when the chemistry calls for it, medication matched to the specific abnormality driving stone formation.

This is also where an integrated practice has an advantage. At Advanced Urology, imaging, stone analysis, the procedure itself, and the metabolic follow-up that prevents recurrence are coordinated within one program rather than handed off across separate offices, which makes it easier to close the loop between removing a stone and stopping the next.

The transformation in stone care is easy to overlook because the symptom, that unmistakable flank pain, has not changed in centuries. What has changed is everything that happens after a patient walks through the door: the ability to read a stone’s chemistry, to choose among precise tools matched to its size and location, and to treat the underlying tendency rather than just the episode. For a region that produces more than its share of stones, that progress is felt one patient at a time.