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Urology (Expert Forum)
ESLW or Ureterscopy?
Answered by
Stephen Liroff, MD - Urology, Pediatric Urology, Peyronie’s disease
Henry Ford Hospital
West Bloomfield - MI
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.
ESLW or Ureterscopy?
by raydiak, Apr 18, 2008 02:33PM
I'm a 63 male. Have had Ankylosing Spondylitis for over 40 yrs. Rib cage and spine fused. On NSAIDS.
Have right hip replaced. Recently diagnosed with Osteopenia and Hypothyroidism.
Have been on Hypertension meds for several years until recently. On Levothyroxine for over
a month now. It seemed to have reduced my blood pressure enough that I've been taken off BP meds.
I have had kidney stone problems for many years About 3 years ago I ended up in ER for extreme pain.
No procedure was performed, stone must have passed on its own but there was no evidence that it did.
Now CT shows multiple small stones in both kidneys and one large about 9mm in left kidney.
My doctor wants to remove it using ureterscope while my previous doctor recommends shock wave therapy.
I want the bigger stone removed as I dread having another ER episode.
From my own research on these procedures I have not been able to decide one way or the other.
The financial aspect of this is that with ureterscopy, its free. VA health benefits pays for it.
VA can also perform ESLW but that hospital is too far away.
I have minimal private insurance which for ESLW is a $500 deductable and probably a lot more $ after that.
Your advice would be greatly appreciated. Ray
Have right hip replaced. Recently diagnosed with Osteopenia and Hypothyroidism.
Have been on Hypertension meds for several years until recently. On Levothyroxine for over
a month now. It seemed to have reduced my blood pressure enough that I've been taken off BP meds.
I have had kidney stone problems for many years About 3 years ago I ended up in ER for extreme pain.
No procedure was performed, stone must have passed on its own but there was no evidence that it did.
Now CT shows multiple small stones in both kidneys and one large about 9mm in left kidney.
My doctor wants to remove it using ureterscope while my previous doctor recommends shock wave therapy.
I want the bigger stone removed as I dread having another ER episode.
From my own research on these procedures I have not been able to decide one way or the other.
The financial aspect of this is that with ureterscopy, its free. VA health benefits pays for it.
VA can also perform ESLW but that hospital is too far away.
I have minimal private insurance which for ESLW is a $500 deductable and probably a lot more $ after that.
Your advice would be greatly appreciated. Ray
Doctor's Answer
by Stephen Liroff, MD, Apr 19, 2008 09:25AM
, Apr 19, 2008 09:25AM
Both approaches to treatment are reasonable. The ureteroscopy one has, I think, more short term risks (damage to the ureter, kidney collecting area, longer anesthesia, risk to your hip: infection, discomforts urinating following the procedure, post operative discomfort from the surgical position) and is more individual skill dependent. At the same time, it is more likely to get out the stone. Extra-corporeal shock wave lithotripsy is most likely faster and has less immediate risks. There are some long term concerns, as you have undoubtedly learned in your research, such as hypertension (high blood pressure) and effects on kidney function. Because of the long term complication issues and the fact that stone fragments (what you have left after the stone is broken into smaller pieces)in the lower poles (lower portion) of the kidney are significantly less like to pass out of your urinary system, as well as the fact that ureteroscopic management is more effective in a single procedure, there has been increasing consideration for ureteroscopic removal of kidney stones.
If the money is not a significant issue, I would go for the ESWL. If you were to do this through the VA, I would expect this to be the usual outpatient procedure, so it would be just the trip there and back. I think that it will be less “wear and tear” on you. Follow-up , I would expect, would be a local issue.
Your chance of having a problem with either procedure is fairly small.
Obviously, there is no "right" way to handle this issue. Both treatments are acceptable.
What you do need is a metabolic work-up (not just a stone analysis) to find out why you make stones and what can be done to prevent you from making more stones. This should be done before an ESWL, if you are going to go that "route." Some urologists and I should think most nephrologists do these.
Good luck!
S.A.Liroff, M.D.
."This information is provided for general medical educational purposes only. It
does not necessarily reflect the opinions of Henry Ford Hospital or the
Vattikuti Urologic Institute. Please consult your physician for diagnostic
and treatment options pertaining to your specific medical condition.”
If the money is not a significant issue, I would go for the ESWL. If you were to do this through the VA, I would expect this to be the usual outpatient procedure, so it would be just the trip there and back. I think that it will be less “wear and tear” on you. Follow-up , I would expect, would be a local issue.
Your chance of having a problem with either procedure is fairly small.
Obviously, there is no "right" way to handle this issue. Both treatments are acceptable.
What you do need is a metabolic work-up (not just a stone analysis) to find out why you make stones and what can be done to prevent you from making more stones. This should be done before an ESWL, if you are going to go that "route." Some urologists and I should think most nephrologists do these.
Good luck!
S.A.Liroff, M.D.
."This information is provided for general medical educational purposes only. It
does not necessarily reflect the opinions of Henry Ford Hospital or the
Vattikuti Urologic Institute. Please consult your physician for diagnostic
and treatment options pertaining to your specific medical condition.”
Ray
S.A.Liroff, M.D.
Procedure was done under some local? anaestesia and sedatives. Don't remember anything. Was it the sedative that gave me temporary amnesia and was that for the purpose of me not remembering any pain? I strained some sandy looking stones and gave it to him to have it analyzed. I feel great, no pain. Only needed to take one percoset when I got home that day. Ray
Thanks for the follow-up.
Now, the effort should be to prevent further stones. You need to have an evaluation for this with 24 hour urine collections and some blood tests. Just analyzing the stone fragments is not enough. Some urologists do this kind of evaluation. I expect that most nephrologists will do this, also. The VA will be able to do this. Your probably going to make more stones if you do not do something to deal with this problem.
S.A.Liroff, M.D.
"This information is provided for general medical educational purposes only. It
does not necessarily reflect the opinions of Henry Ford Hospital or the
Vattikuti Urologic Institute. Please consult your physician for diagnostic
and treatment options pertaining to your specific medical condition.”