Kidney stones may be among medicine’s most painful conditions, but through cutting-edge technology, innovative surgical techniques, and a passion for discovery, Dr. Zachary Tano is helping lead the evolution of kidney stone care on Staten Island.

BY AMANDA McCOY • PHOTOS BY AMESSE PHOTOGRAPHY

For something often no larger than a pencil eraser, a kidney stone has the extraordinary ability to bring life to a standstill. Affecting roughly one in ten Americans, the tiny mineral deposits can trigger excruciating pain as they travel through the urinary tract, sending countless patients to the emergency department each year. While most stones pass on their own with time and hydration, others can become considerably more complicated, growing to several centimeters in diameter, settling into difficult-to-access areas like the lower pole of the kidney, blocking the flow of urine, or branching throughout the kidney in coral-like staghorn formations. In these complex cases, specialized medical care is critical, as forgoing treatment can cause not only debilitating pain, but serious complications like infection and kidney damage.

While the prevalence of kidney stones is on the rise across the country, Staten Island has a notably high volume, driven in part by dietary habits, chronic diseases like obesity, and dehydration. Northwell Health took action, expanding Staten Island University Hospital’s Smith Institute for Urology in 2024 to meet the borough’s growing need for multispecialty urologic care. That same year, the hospital recruited Zachary Tano, MD, a board-certified, fellowship-trained urologist and surgeon with advanced expertise in kidney stone disease. It was a perfect fit; Dr. Tano had recently completed a rigorous urology fellowship with the University of California (Irvine) Medical Center, one of the nation’s leading endourology and stone disease programs, and he was looking for a professional home that shared his values of creativity, collaboration, and innovation.

“My fellowship mentors helped me develop a new way of creative thinking – exploring ideas and asking difficult questions,” said Dr. Tano, whose interest in medicine was ignited during a deployment to Afghanistan while serving in the U.S. Navy. “I was looking for a place where I could bring that same energy, a place where we could continually critique and refine our practice, improve patient outcomes through modern evidence-based protocols, and collaborate to develop new technologies and treatments. We have an outstanding team here at the institute, from the specialists to the nutritionists and administrative assistants. There’s a culture of collaboration.”

Dr. Tano’s practice centers on complex stone disease, caring for patients with stones that are large, recurrent, lodged in difficult-to-reach areas, or irregularly shaped. (A staghorn, for example, forms branching structures that resemble a piece of coral or deer antlers.) After an extensive evaluation, Dr. Tano sits with each patient to discuss options, explain risks, answer questions, and offer guidance for stone disease prevention. “I’ve passed multiple stones myself, so I can speak firsthand to what this experience is like for patients,” he noted.

If medical intervention is necessary and the patient elects to undergo treatment (“Surveillance is always an option,” explained Dr. Tano. “We will never force a patient’s hand.”), they have the full spectrum of cutting-edge, minimally invasive innovations available to them at the institute. And as Dr. Tano explained, it’s an exciting era for stone disease specialists, as new technology is emerging that the doctor described as “the most significant functional improvement” since the 1980s – aspiration ureteroscopy. During the procedure, a tiny camera is guided through the urinary tract to the kidney, where a laser breaks the stone into fine sand-like particles while built-in suction simultaneously vacuums away the debris. It shortens recovery, lowers infection risks, and significantly boosts stone-free rates.

“We are now in the age of aspiration ureteroscopy,” explained Dr. Tano. “It’s an outpatient, incision-free procedure that’s allowed me to take on larger stones that were traditionally treated with Percutaneous Nephrolithotomy (PCNL), which is a much bigger procedure and requires an overnight stay in the hospital. With aspiration ureteroscopy, I avoided more than 30 PCNLs last year alone.”

Patient safety is a key driver of Dr. Tano’s practice, and in the OR, he implements a visualization technique that helps reduce bleeding, protects healthy kidney tissue, and often spares patients an uncomfortable post-op tube. “I visualize exactly where I want to puncture and manipulate my needle tract so it goes directly into the center of the kidney, which has the least amount of blood supply. Because I can visualize in real time, I’m able to avoid injury to any other areas of the kidney. When I’m done, the patient has a stent that’s removed a week later rather than an uncomfortable tube.”

Nationally, kidney stone care continues to evolve at a remarkable pace, and Dr. Tano is invested in several research initiatives to help move the needle. “There are so many interesting questions in urology, and it’s an honor when I can pass on my findings to contribute to the greater body of work. There’s still a lot of unknown on kidney stone formation and no complete, lab-based model that can predict when stones will form. We are hoping to inspire more young people to get involved as it’s such an exciting time to be in urology.”

Data confirms that kidney stone rates tend to spike in the summer, and Dr. Tano offers his fellow Staten Islanders his foremost word of advice: stay hydrated. “It’s hot outside, and the most protective thing we can do is to dilute the factors that can cause stone formation. Drinking 96 ounces of fluid per day is the gold standard, but if you can’t do that, try to increase your normal intake. A helpful tip is to keep a 16-oz glass by your sink and drink one full glass of water during your morning and evening routine, plus at least one or two more glasses throughout the day.”

Smith Institute for Urology at Staten Island University Hospital — 1441 South Ave, Ste 701
northwell.edu/doctors-offices/northwell-health-physician-partners-smith-institute-for-urology-at-staten-island