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Urology (Expert Forum)
Large kidney 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.
Large kidney stone
by Jana, Jan 14, 2000 12:00AM
46 year old woman with moderate medical knowledge.Have had right flank pain intermitantly (with motion, pressure to area) subsides when in coil position after 10-20 mins) for about one year. Cat and xray reveal stone slightly >1cm at juncture or kidney and tube. Doctor first mentioned flank surgery to remove. What are pros cons of this,complications? I am scheduled 1/18 for the wave thing and am unclear and have questions on this. Dr. mentioned He would go up with a scope thing blast the stone and leave a shunt in for a week, remove it and see what happens.
My questions:Why has my kdney not passed stone earlier? there seems to great chance a zillion fragmented stones won"t pass either. how wide is the shunt, is it there to make passage of fragments easier, how. Does Dr.: Basket stone,then zap it and pull out major parts or does it fragment to distant areas of kidney injuring area and to become seeds stuck as potential seeds for future stones which also won't pass. I now only have two stones, one smaller in upper area of kidney.
Am tired of pain, family cannot tolerate me down with pain.
Would flank removal be more prudent? Why or why not?
Appreciate your time, I was pre-med ucla biochem major, maybe
you got the space I never took, deciding I wanted to be a MOTHER. thank you ,jana
Dr. prescibed post-op vicodan. it barely touches pain now, i requested morphine and he laughed. could i safely take diazepam?
I anticipate excruciating post op pain with that shunt.
My questions:Why has my kdney not passed stone earlier? there seems to great chance a zillion fragmented stones won"t pass either. how wide is the shunt, is it there to make passage of fragments easier, how. Does Dr.: Basket stone,then zap it and pull out major parts or does it fragment to distant areas of kidney injuring area and to become seeds stuck as potential seeds for future stones which also won't pass. I now only have two stones, one smaller in upper area of kidney.
Am tired of pain, family cannot tolerate me down with pain.
Would flank removal be more prudent? Why or why not?
Appreciate your time, I was pre-med ucla biochem major, maybe
you got the space I never took, deciding I wanted to be a MOTHER. thank you ,jana
Dr. prescibed post-op vicodan. it barely touches pain now, i requested morphine and he laughed. could i safely take diazepam?
I anticipate excruciating post op pain with that shunt.
Doctor's Answer
by HFHS M.D.-BL, Jan 14, 2000 12:00AM
Dear Jana,
It is highly unlikely that a stone >1cm at the UPJ (ureteropelvic junction) would pass on its own. Most stones >.5 cm do not pass spontaneously, and they will require some type of urologic intervention. Different options exist for dealing with large stones such as yours. ESWL (Extracorporeal Shock Wave Lithotripsy) or PCNL are the two most common modalities for dealing with a stone of this size at the UPJ. ESWL does not involve an incision like PCNL. PCNL involves a small flank incision through which a port is placed, and the stone is either broken up with a “shockwave”, laser, or just pulled out with a gripping device.
For your stone ESWL would probably make the most sense. You would be able to avoid an incision this way. However, there are some stones that do not respond to ESWL or they are in a position that makes ESWL therapy difficult. After an ESWL some urologists leave a stent (a very small caliber soft plastic tube) in place that runs from the pelvis of the kidney down into the bladder. This stent insures that the kidney is properly draining and helps stone fragments to pass and not become obstructed. Some patients experience minor discomfort with their stent especially during urination. This stent is usually removed about a week after the ESWL after an x-ray has shown that the bulk of your stone burden has been passed.
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.-BL
*keyword
It is highly unlikely that a stone >1cm at the UPJ (ureteropelvic junction) would pass on its own. Most stones >.5 cm do not pass spontaneously, and they will require some type of urologic intervention. Different options exist for dealing with large stones such as yours. ESWL (Extracorporeal Shock Wave Lithotripsy) or PCNL are the two most common modalities for dealing with a stone of this size at the UPJ. ESWL does not involve an incision like PCNL. PCNL involves a small flank incision through which a port is placed, and the stone is either broken up with a “shockwave”, laser, or just pulled out with a gripping device.
For your stone ESWL would probably make the most sense. You would be able to avoid an incision this way. However, there are some stones that do not respond to ESWL or they are in a position that makes ESWL therapy difficult. After an ESWL some urologists leave a stent (a very small caliber soft plastic tube) in place that runs from the pelvis of the kidney down into the bladder. This stent insures that the kidney is properly draining and helps stone fragments to pass and not become obstructed. Some patients experience minor discomfort with their stent especially during urination. This stent is usually removed about a week after the ESWL after an x-ray has shown that the bulk of your stone burden has been passed.
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.-BL
*keyword
Member Comments (31)
by Jana, Jan 15, 2000 12:00AM
To: Kidney/Urinary Stones
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by carryl, Mar 12, 2000 12:00AM
To: Kidney/Urinary Stones
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by jenifer, Mar 21, 2000 12:00AM
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by karma, Mar 21, 2000 12:00AM
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by jenifer, Mar 21, 2000 12:00AM
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by karma to jenifer, Mar 21, 2000 12:00AM
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by jenifer, Mar 21, 2000 12:00AM
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by jenifer, Mar 22, 2000 12:00AM
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by karma, Mar 23, 2000 12:00AM
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by Eternal^Stones, Mar 23, 2000 12:00AM
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by karma to eternal stones, Mar 23, 2000 12:00AM
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by jenifer, Mar 24, 2000 12:00AM
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by karma, Mar 24, 2000 12:00AM
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by Ann, Mar 29, 2000 12:00AM
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by Ramona, Apr 03, 2000 12:00AM
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by Jennifer 44