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Urology (Expert Forum)
Uteric Stone
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Uteric Stone
by J, Oct 09, 1999 12:00AM
I was born with bi-lateral duplex ureters. At age 5 I had the left ureter reimplanted to correct refluxing. Both my kidneys are smaller than the ave adult and badly scarred as is my bladder from many infections. Approx 5 weeks ago I was admitted to hospital with renal colic and inability to pass urine. I wasn't catheterized but my drinking and output were monitored through the night. I had a basic x-ray which showed up a small white shape with a halo around it. I was told this was a kidney stone that was sitting at the end of my left ureter leading into my bladder. I had an ultrasound scan done 2 days later to confirm whether a stone had passed through my left ureter, they were looking for dilation of the ureter but found everything to be normal. They did not pick the stone up on the ultrasound scan. I was discharged from hospital to wait for a referral to see a Urologist. While in hospital the Urologist wouldn't see me until there was firm evidence. I have been told I will see the Urologist in January 2000 which is a very longtime to wait. My GP is aware of this. I currently drink approx 4 to 6 pints daily and no caffeine. The stone is still in the same place, I know this as the pain in my groin has not shifted. I was examined by my GP last Tuesday, he pressed very hard on the area where the stone is and since then I have renal colic again, sore throat, feel generally unwell. I have rung the GP and he said to drink plenty, take painkillers and keep mobile.
My question is with the reimplantation of my left ureter at an angle to correct refluxing and the stone being at the end of my left ureter, will this stone be able to pass out ?
It has been approx 5 weeks and I'm drinking 4 to 6 pints daily and still no sign of it passing out. I would like to avoid surgery if possible as I'm badly scarred and do not want future problems from a kidney stone removal. If something has to be done, would I be a suitable case for shockwave treatment ?
Please advise and thank you for your help.
My question is with the reimplantation of my left ureter at an angle to correct refluxing and the stone being at the end of my left ureter, will this stone be able to pass out ?
It has been approx 5 weeks and I'm drinking 4 to 6 pints daily and still no sign of it passing out. I would like to avoid surgery if possible as I'm badly scarred and do not want future problems from a kidney stone removal. If something has to be done, would I be a suitable case for shockwave treatment ?
Please advise and thank you for your help.
Doctor's Answer
by hfhs M.D.-AK, Oct 12, 1999 12:00AM
Dear J,
It is difficult to assess your situation, since only a routine X-ray was performed. An IVP with dye would be more appropriate. It would settle the issue of a stone vs phlebolith (calcified vessel), complete obstruction vs partial , hydronephrosis, the function of the affected kidney, and possibly show the angle of implantation of the ureter. There are several ways to reimplant the ureter in an antireflux fashion, and a cross Cohen procedure would pose a substantial problem if a stone is identified at the junction of the ureter and the bladder and you had a significant obstruction.
In this position in the pelvis, you would not be a candidate for Shock Wave Lithotripsy because the surrounding bony structure of the pelvis doesn't allow the shock waves to penetrate. A standard retrograde procedure would also be difficult, do to the angle of the ureter in the bladder wall. Depending on the size of a stone, it would still have a chance to pass, and a brisk diuresis from drinking fluids may help. As long as you are able to tolerate the pain, you remain infection free, and your kidney is not completely obstructed, a trial to pass the stone in a spontaneous fashion is acceptable. Even though, most ureteral reimplants are narrow and decrease to chances of stone passage I have seen success. However, if you are clinically in pain or in danger of renal function loss, either an antegrade procedure or open stone removal may become necessary.
Find out from your GP what type of reimplant was done by your surgeon. Consider a contrast based study (IVP) or spiral CT scan with reconstruction. These studies will identify a stone, and if an obstruction is present. If a stone is present, and is causing you pain, you may want to see the urologist a little earlier. Good Luck!
The information provided in this forum is presented for general educational purposes only. Specific questions you have pertaining to your health should always be directed to your personal physician.
Sincerely,
HFHS M.D.-AK
*keyword: Renal Calculi
It is difficult to assess your situation, since only a routine X-ray was performed. An IVP with dye would be more appropriate. It would settle the issue of a stone vs phlebolith (calcified vessel), complete obstruction vs partial , hydronephrosis, the function of the affected kidney, and possibly show the angle of implantation of the ureter. There are several ways to reimplant the ureter in an antireflux fashion, and a cross Cohen procedure would pose a substantial problem if a stone is identified at the junction of the ureter and the bladder and you had a significant obstruction.
In this position in the pelvis, you would not be a candidate for Shock Wave Lithotripsy because the surrounding bony structure of the pelvis doesn't allow the shock waves to penetrate. A standard retrograde procedure would also be difficult, do to the angle of the ureter in the bladder wall. Depending on the size of a stone, it would still have a chance to pass, and a brisk diuresis from drinking fluids may help. As long as you are able to tolerate the pain, you remain infection free, and your kidney is not completely obstructed, a trial to pass the stone in a spontaneous fashion is acceptable. Even though, most ureteral reimplants are narrow and decrease to chances of stone passage I have seen success. However, if you are clinically in pain or in danger of renal function loss, either an antegrade procedure or open stone removal may become necessary.
Find out from your GP what type of reimplant was done by your surgeon. Consider a contrast based study (IVP) or spiral CT scan with reconstruction. These studies will identify a stone, and if an obstruction is present. If a stone is present, and is causing you pain, you may want to see the urologist a little earlier. Good Luck!
The information provided in this forum is presented for general educational purposes only. Specific questions you have pertaining to your health should always be directed to your personal physician.
Sincerely,
HFHS M.D.-AK
*keyword: Renal Calculi