stones stuck in urethea tube

[bob-p]

   I have just been released from the hospital after dealing with
   severe pain from passing several stone fragments. I had a large
   stone about 24mm in size. A Liptotripsy was done wich only broke
   the stone into several fragments.  the remaining pieces are
  now jammed at the end of my tube just before the bladder. I am
  experiencing mild discomfort from timt to time now. My doctor
  tried to pass the wire up but could not get passed the stones.
  I feel like I am in a wait and see situation. would a second
  Liptotripsy procedure be the way to go? Nothing is happening
  on its own. They are not sure how many pieces are left to pass
  even after many xrays and two IVP already.

--------------------------------------------------------------------------
Dear Bob,
The medical term for this condition is called Steinstrasse.  In German it stands for stone street.  What has happened is just how you explained it, the fragments of the stone are now in the ureter at the ureteralvesical junction, the narrowest portion of the ureter, just outside the bladder.  They have lined up in a column and are acting as an obstruction.  You are correct about inquiring if a second lithotripsy should be done.  In some situations a larger lead fragment blocks the ureter and prevents the smaller fragments from passing.  If the stone column is high enough and is outside the bony  pelvis, a second lithotripsy is feasible.  However in your case, it sounds as if the stone are very low inside of the bony pelvis and performing a second lithotripsy is not an option.  Some urologists will recommend placing a stent in place before lithotripsy for a stone the size you described.
Your doctor has several options on how to remove the stone fragments.  He can give you pain medication and let you pass them on your own.  He can attempt to place a wire followed by a stent, to keep you comfortable, help dilate the ureter and let you pass them on your own.  He can perform ureteroscopy , looking into the ureter itself, and attempt to stone basket the fragments, pulling them out one by one.  He could break the stone fragments up further with a laser and remove smaller fragment, and last but not least, he may be able to push the stone up higher in the ureter or kidney and perform a second lithotripsy.  I’m sure there are other modifications of the options I provided and you urologist must due what he is comfortable with as well as what he believes is the correct procedure.
Although I’m sure the obstruction is quite painful, you will not likely do any longterm damage to the affected kidney.  You will probably be getting follow-up X-rays to see if the stones are passing or moving.  If your life style does not permit having this pain for several days to weeks, tell your doctor and he can recommend a more definitive therapy from the list I mentioned above.
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:Kidney stones