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Urology (Expert Forum)
Multiple stones, one large, is surgery necessary
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
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.
Multiple stones, one large, is surgery necessary
by NiteowlTX, May 14, 2004 12:00AM
Because of pain, and blood in urine, I was sent for IVP by my doctor. I'm continuing on to Urologist, but I'd like your assessment / opinion of these IVP results, regarding whether I can hope for non-surgical treatment, and if this report indicates serious matters I should be prepared to ask questions about, or research for myself to better understand.
IVP Findings
A 1.5 cm oval calculus at left renal pelvis, a 2 mm at superior pole left kidney, a 3 mm at midpole right kidney, and a 2 mm at inferior pole right kidney. Mild prominence of left renal collecting system. Phleboliths seen in left pelvis.
There is also a 4 mm calcification within the left inferior pelvis which apears to reside within the distal left ureter near the left UVJ. There is mild dilatation of the left ureter throughout its length, and mild dilatation of the left renal collecting system. Clearing of contrast suggest not complete obstruction.
Thanks in advance for you assistance.
IVP Findings
A 1.5 cm oval calculus at left renal pelvis, a 2 mm at superior pole left kidney, a 3 mm at midpole right kidney, and a 2 mm at inferior pole right kidney. Mild prominence of left renal collecting system. Phleboliths seen in left pelvis.
There is also a 4 mm calcification within the left inferior pelvis which apears to reside within the distal left ureter near the left UVJ. There is mild dilatation of the left ureter throughout its length, and mild dilatation of the left renal collecting system. Clearing of contrast suggest not complete obstruction.
Thanks in advance for you assistance.
Doctor's Answer
by Kevin Pho, MD, May 16, 2004 12:00AM
, May 16, 2004 12:00AM
There are several options for kidney stones.
Shockwave lithotripsy (SWL) — SWL is the treatment of choice in many patients who need help passing a stone, and is particularly good for stones in the renal pelvis and upper ureter. A high energy shock wave is directed toward the stone, passing through the skin and bodily tissues and causing a release of energy at the stone surface. This energy causes the stone to break into fragments that can be more easily passed.
Percutaneous Nephrolithotomy (PNL) — Extremely large or complex stones, or stones resistant to shock wave lithotripsy, may require removal using a percutaneous approach. In a percutaneous approach, small telescopic instruments are passed through the skin and into the urinary tract to access the stone directly.
Ureterorenoscopy — Ureterorenoscopy is often used to remove stones obstructing the middle and lower portion of the ureter. In ureterorenoscopy, a very small telescopic instrument is passed up through the urethra and bladder and into the ureter. The telescope is moved through the ureter until it encounters the obstructing stone, which can then be removed.
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.
Kevin, M.D.
Medical Weblog:
kevinmd_b
Bibliography:
Premingner. Patient information: Kidney stones. UptoDate, 2004.
Shockwave lithotripsy (SWL) — SWL is the treatment of choice in many patients who need help passing a stone, and is particularly good for stones in the renal pelvis and upper ureter. A high energy shock wave is directed toward the stone, passing through the skin and bodily tissues and causing a release of energy at the stone surface. This energy causes the stone to break into fragments that can be more easily passed.
Percutaneous Nephrolithotomy (PNL) — Extremely large or complex stones, or stones resistant to shock wave lithotripsy, may require removal using a percutaneous approach. In a percutaneous approach, small telescopic instruments are passed through the skin and into the urinary tract to access the stone directly.
Ureterorenoscopy — Ureterorenoscopy is often used to remove stones obstructing the middle and lower portion of the ureter. In ureterorenoscopy, a very small telescopic instrument is passed up through the urethra and bladder and into the ureter. The telescope is moved through the ureter until it encounters the obstructing stone, which can then be removed.
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.
Kevin, M.D.
Medical Weblog:
kevinmd_b
Bibliography:
Premingner. Patient information: Kidney stones. UptoDate, 2004.
