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Avatar universal

My kidney stone

  My history: I am a 37 y/o physician with a two week hx of an approximately 5 x 2 mm opaque stone (h/o calcium phosphate/oxalate stones) lodged in the left UVJ. Initial renal colic abated and now only intermittent symptoms of post voiding LLQ ache. No evidence of infection, hematuria. Trying aggressive hydration for 2 weeks without result.
  The question I have is: what are my options for treatment... specifically - is a trial of ESWL indicated or must I undergo ureterohydroscopy with basket extraction? My symptoms are mild at present and I have been only advised 'surgery' by my urologist (and I would prefer a noninvasive approach if possible!)
  Please assist ASAP.
  Thank you.
1 Responses
Avatar universal

_

Dear AJ,
The goals of treating kidney stones are to relieve pain, remove the stone, preserve kidney function and prevent recurrence of stones.  The majority of calculi less than 4 to 5 mm in size pass spontaneously.  Obstruction from a stone, whether partial or complete, causes a progressive decrease in renal function.  Detectable renal damage usually does not occur in previously normal kidneys until complete obstruction has been present for over 4 weeks or more.
The optimal treatment for distal ureteral stones is controversial.  One option is continued conservative management with increased fluid intake and straining the urine for stone fragments.  As far as ESWL versus ureteroscopy, convincing arguments for both have been advanced.  The contraindications for ESWL are pregnancy--may cause miscarriage/birth defects, uncontrolled coagulopathy for obvious reasons, and uncontrolled hypertension--this may exacerbate hemorrhagic complications.  A febrile UTI is also a contraindication.   Calcium oxalate monohydrate, calcium phosphate (apatite) and cystine stones are difficult to fragment with ESWL.  It is also more difficult to image the distal ureteral calculi in ESWL and the need for re-treatment is higher.  
With ureteroscopy, the success rates with single treatment are higher.  The following are indications for endoscopic management of ureteral calculi: 1)  stone size >1 cm diameter;  2)  stones associated with distal obstruction;  3)  distal ureteral stones in women of childbearing age;  4)  multiple stones;  5)  impacted stones;  6)  ESWL failures.
The good thing is that both ESWL and ureteroscopy are performed in an outpatient setting.  I hope this is enough information to help you make an informed decision.  More individualized care is available at the Henry Ford Hospital and its urban campuses by calling  (1 800 653 6568). We can also arrange local accommodations through this number if this is your need. Please bring any physicians' notes and lab test results that you  may be able to obtain. These will help us greatly.
HFHS M.D.-JL
*keyword:ureteral calculus, kidney stone, ureteroscopy





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