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Urology (Expert Forum)
Perforated Ureter
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.
Perforated Ureter
by Dan__0, Feb 25, 1999 12:00AM
I am a 36 year old male and have been passing calcium oxalate stones since I was 19 years old. For the first time, I had a large stone become impacted in my ureter. As a result, underwent 2 ureteroscopic surgeries to remove the stone. The first procedure utilized the basket technique and was unsuccessful in removing the stone. The second procedure (4 weeks later) utilized a laser and was successful breaking up the stone. Both procedures required a ureteral stent. Today, I had a KUB x-ray to determine if the stent could be removed. My urologist indicated that the x-ray revealed that apparently several pieces of the stone were now outside of the ureter and had possibly passed through the ureter during the second procedure. He wants to leave the stent in for at least another 2 weeks and repeat the KUB x-ray. Fortunately, I have experienced minimal discomfort after both procedures. I was surprised that a stone could perforate my ureter and not result in significant complications.
My questions are as follows:
1.Should I be concerned that my ureter was perforated by stone fragments during the laser procedure?
2.Why didn’t I experience significant discomfort from the perforation?
3. Should I be concerned that the stone is now floating in my abdominal cavity?
4. Is perforation a common occurrence as the result of the removal of impacted stones or should I find another urologist?
Thanks.
My questions are as follows:
1.Should I be concerned that my ureter was perforated by stone fragments during the laser procedure?
2.Why didn’t I experience significant discomfort from the perforation?
3. Should I be concerned that the stone is now floating in my abdominal cavity?
4. Is perforation a common occurrence as the result of the removal of impacted stones or should I find another urologist?
Thanks.
Doctor's Answer
by hfhs M.D.-AK, Feb 25, 1999 12:00AM
_
Dear Dan,
The concern after perforation of the ureter once the stent is removed would be a stricture. This is a narrowing that can cause obstruction, just like a stone can. You will not know if a stricture forms in that ureter for some time after the stent is removed.
Perforation of the ureter is not painful during the procedure because you are under anesthetic. If treated properly with a stent to avoid obstruction and proper healing you may never know the perforation is present.
Losing stone into the abdomen (more specifically the retroperitoneum) is really not a problem without infection. You would know if the stone was infected because you would still have problems with fevers and chills.
Perforation is an uncommon occurrence, but when a stone is impacted in the ureter, anything can happen. It is difficult to separate the stone from the wall of the ureter without tearing or causing perforation. I don’t think you need to find another urologist, he or she seems to be doing the right thing as well as keeping you comfortable. Again , only time will tell if you will have a long-term problem with a stricture of the ureter. Let’s hope you don’t!
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:Ureteral Perforation
