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Obstruction or Not? How best to handle with conflicting Dr. opinions?
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Obstruction or Not? How best to handle with conflicting Dr. opinions?

I am a male who recently turned 40 and had an EBT CT Scan performed.  The EBT Scan identified very good health in all areas of my heart and body with the exception of a large kidney stone.  I have never felt pain, symptoms or discomfort at all.  Due to the clear identification of a large kidney stone on the EBT Scan, I went to visit a Urologist.

At the Urologist, minor traces of blood were found in my urine that are not visible to the eye.  Based on the EBT Scan and the minor traces of blood, the action plan included; X-rays with contrast, additional urinalysis and an IVR to look at the inside of my bladder.

The x-rays identified a large stone right in the middle of my right kidney approx 50 mm x 20 mm.  The mother of all stones, as the Dr. put it.  The x-ray also shows another very small grouping of 3-4 very small stones separate from the mother stone.  There were no issues with my bladder identified and the blood in the urine was attributed to the large kidney stone.
Based on this information the stone clearly needs to be removed via a percutaneous nephrostolithotomy.  Based on the information shared above, I can now present my question:

Dr. A believes I have a congenital obstruction based on the x-rays and is recommending that the obstruction issue be addressed with a second procedure done in conjunction with the removal of the stone(s).  The second procedure he recommends involves clipping the kidney/ureter connection open wider and then placing a stent for 4-6 weeks.  Dr. A was not supportive of simply removing the stone and then taking a wait and see.

Dr. B, (second opinion) looked at my x-ray and indicated that he could not say for sure that I have an obstruction.  He definitely says the percutaneous procedure needs to happen to remove the stone.  No doubt about that given the size of the stone.  However, he feels that the kidney is likely irritated and inflamed thus complicating the ability to read the x-rays and actually see what is going on inside the kidney specific to the existence of an obstruction, or not.

Dr. B is recommending to take the stone(s) out, wait about 4-6 weeks, do another contrast x-ray study and see what it shows.  He indicates that if an obstruction is found after the kidney has had a chance to heal from the removal of the stone(s), that the obstruction can be addressed non-surgically on an out-patient basis with a laser followed by a stent by going back in through my penis.  

Dr. B also raised some questions about the angle of entry for the percutaneous procedure by indicating a need to remove the stone by entering below the ribs.  He indicated it will be hard to cut the kidney/ureter opening wider and placing a stent by coming into the kidney from below.  He mentioned additional risk for the lungs by trying to do both procedures from above, between the ribs.

Any thoughts or input that you might provide to help me reconcile these two opinions will be appreciated.  

Thanks.
  

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It will be difficult to me to come up with the opinion without being involved with th case myself.  

However, the points made by Dr. B are good ones - there is certainly additional risks to the lungs due to the approach.  Waiting 4-6 weeks after taking the stone out is certainly a reasonable, less aggressive approach.

This goes to show that there are multiple ways to solve the same problem.  This does not mean one way is better than another.  Clearly, Dr. B's approach is a more conservative one.  You may want to obtain another opinion to come up with a solution that is comfortable for you.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.
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