When I read the first edition of "The Kidney Stones Handbook: A Patient's Guide to Hope, Cure and Prevention," I was very surprised to see it written by a patient. My first impression was to call the author to express my outrage at being left out since the stone prevention laboratory protocol I had designed was not included. Little did I know that Gail Savitz would eventually ask me to co-author the new book. In Gail I found a kindred spirit, someone who felt as passionately as I did about bringing kidney stone prevention information directly to the millions of patients who suffer from this terribly painful affliction.

I never expected that treating kidney stone disease would someday become such a large part of my life. As a urologist, my focus during training had always been on the surgical treatment of kidney stones. Very little instruction was given concerning metabolic testing, analysis, or preventive measures.

When I finished my urology training in 1982, I went to work at a large medical clinic. Being the new guy in town meant that I had plenty of time on my hands while I was getting started. Some of my first patients happened to have kidney stones. After I treated their stones, they actually had the audacity to ask me to help them stop making more! Such impudence! I didn't realize then how little I actually knew about the subject. After all, I had been well trained at two of the very best urology training centers in the country. There wasn't a stone made that I wasn't prepared to treat. I knew all the surgical techniques cold-but I had to start from scratch to learn how to really help my patients stop new stones from forming.

Because I wasn't overly busy during those first few months, I did some library research and starting organizing laboratory protocols to make it easier to gather the necessary information. I questioned my colleagues about kidney stone disease and tried to decipher the complicated and often confusing medical articles written on the subject. Eventually, I came to realize that this was a grossly misunderstood field because of a lack of training in medical school and residency, the high cost and difficulty of obtaining the necessary laboratory studies, and the complicated systems of analysis and interpretation. It's almost as if most of the "experts" had conspired to make the subject of stone prevention as complex as possible to enable only a relatively few doctors to offer the service. I decided to try and make it simple by using a sophisticated "expert" computerized analysis so any physician who wanted it could get a complete evaluation of a patient at a reasonable price, along with a written summary of the conclusions and possible preventive therapies.

Ten years ago, this program became commercially available through Roche Biomedical Laboratories (now Laboratory Corporation of America, or "LabCorp") and won the prestigious Thirlby Award of the American Urological Association.

Despite the program's availability, most patients were still not getting this prevention testing or treatment. Some of my urology colleagues actually told me they were not interested in preventing kidney stones because they would not be doing as much surgery and would lose money! Eventually it became clear that the only way to force some of my reluctant medical colleagues to emphasize kidney stone prevention was to go over their heads and educate their patients. Imagine, educating patients! Revolutionary! And if enough patients demanded stone prevention testing and treatment from their physicians, we would soon find a way to accommodate them.

We now know that we can find treatable causes for kidney stones if we look hard enough. It has also been shown that virtually every patient who follows treatment based on appropriate testing, proper interpretation, and sound medical principles will substantially reduce or eliminate all future kidney stone production. If your doctor doesn't advise such testing in your case, ask him or her about it - and, if necessary, be prepared to demand it.

That's why I decided to help Gail revise and update this new edition.

Stephen W. Leslie, MD FACS
Assistant Clinical Professor
Department of Urology Medical College of Ohio