Question Title: destroyed ureter

At the end of March I woke up in the middle of the night in pain, I went to the emergency room where the attending physician diagnosed probable kidney stones and ordered an IVP. After 4 hrs in the xray lab with numerous xrays taken, they still couldn't see a stone, only that there was a blockage. He set up an appointment with an urologist for the next day. Another xray in the urologist's office still didn't show a stone. He said that he suspected a stone at the bladder/ureter junction. He advised doing an exploratory with possible removal via a ESWL or extraction with a basket with possible placement of a stint, all to be done in outpatient surgery. He said to go to the hospital at 11:00 the next day and I would probably be home by 5:00. I left the hospital 10 days later. The stone was in the kidney and during the basket extraction of a 1.5 X 1.0 X .7 cm uric acid stone he destroyed my ureter, it actually came out with the stone(8.5cm long). 2 days later an ileal ureter was "installed" to replace the entire ureter.
My questions are should he have ordered a CAT scan or MRI to see where and how big the obstruction was? I've read of the ureter being damaged during an extraction thereby requiring a stint but how often is the ureter yanked out with the stone?
Isn't a 1.5 X 1.0 X .7 calculus too large to be pulled through a 2 mm opening?
What alternatives could or should have been used? I now have a condition that has to be monitored for the rest of my life. I'm not one for rushing to a lawyer on the slightest whim nor do I believe in frivilous lawsuits. I've been through hell with the surgery and recovery. Is this case just an unforunate experience to be forgotten or should I at least look into pursuing a negligence lawsuit?

I don't have a lawyer and I don't know who to ask or where to turn. I don't want to go to some lawyer and hear "oh yes you definitely have a case, just sign here and leave a check for $xxxx.xx as a retainer". I trust lawyers as much as my ex-urologist, but sometimes they do provide a useful service.

Thank you for reading about my experience.

Don S.

Dear Don,
The presentation you describe is the usual presentation for a uric acid(radiolucent) stone. This means the stone cannot be seen on X-ray. There are many different ways to remove a stone and the method is usually left to the urologist’s best judgment. I don’t think that a CT scan would offer much to your case other than to let the urologist know the size of the stone.
Complications have been reported in upto 20 % of ureteroscopic cases. Most of these are minor and involve urinary extravisation usually managed by placement of a stent. The most serious injury is a ureteral avulsion, generally caused by forceful extraction of a calculus. A ureteral avulsion is generally treated with an open repair as was done in your case. I’m not sure why an ileal ureter needed to be used but I was not involved in your case.
I don’t want to comment on your lawsuit status, but if you signed a consent for the procedure, avulsion of a ureter during a ureteroscopic procedure is a known complication and not malpractice. I think you are unfortunate to have such a complication, but every procedure has its percentage of bad outcomes. Good luck, I hope your ileal ureter works well for you.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).

Sincerely,
HFHS M.D.-AK
*keyword:Ureteroscopy

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