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Re: kidney surgery

Posted By HFHS M.D.-BE on April 14, 1999 at 10:32:27

Topic Area: Kidney/Urinary Stones
I've had lithotripsy twice for kidney stones,90 and 98. Now I have them again and after going through a number of tests lithotripsy is not an option because I have a diverticulum (pouch) in the kidney and the stones are in it.Because of the location PNL is not an option.Only open kidney surgery to remove that part of the kidney.My whole life I've had repeated infections.I'm scared to death of this surgery.Nothing is blocked and I'm not having any pain right now. Has anyone else had this? Please Help!!





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Dear Peggy,
It is a relief that you are not suffering from a lot of pain and other symptoms presently, because you know how uncomfortable that can be.  However, there is good medical reasoning to remove the stones and obliterating the diverticulum now, because the potential for infection exists ( as you well know) , which could trigger a host of other worse problems. The best overall treatment approach for diverticula with stones is the percutaneous approach (PNL) with very good results and lower  morbidity. Other minimally invasive approaches are  also utilized, such as laparoscopy or ureteroscopy.  Ureteroscopy is the use of an illuminated scope which enters the body through the urethra, goes into the bladder, up into the ureter and the kidney.  Laparoscopy  is also used, however, less frequently. Open surgery is one option, as you mentioned, but has the disadvantage of a bigger and more painful incision and a longer recovery period, yet in some circumstances the only option. All these procedures have certain risks and benefits inherent to them. You should discuss all these with your urologist, and may want to seek a second opinion to finalize your decision.
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.-BE
*keyword: calyceal diverticula





2 Responses
Avatar universal
Posted By Peggy on April 15, 1999 at 22:06:54
Thank you so much for your reply. Unfortunately, ureteroscopy wasn't an option due to the location of the stones(I believe upper pole) and the fact that after my cystoscopy and retrograde on 3/30, the doc said the dye didn't even fill the diverticulm so I think it it closed. My right kidney is also half the size of my left one and shows signs of something called clumping. Possibly from infections I've suffered my whole life(I'm 41)? Every time I'm on an antibiotic,currently Cipro 500mg 2x per day, it will clear up the infection and 3 days later it's back again. After I finished my last prescription,I was put on a supression of Bactrim ds. After one week the infection reoccured. I really wanted to opt for the PNL but my doc said because of my anatomy, it would be too difficult. he consulted with another urologist who specializes in PNL and he agreed. I need to clear this up or I'll wind up losing my whole kidney. So the open surgery is scheduled for this Tuesday 4/20. I had a renal angiogram yesterday. I'm still very scared and wish I Knew more about what to expect. Wish me luck. I'll let you know how it goes.(Probably not for a while tho)




Avatar universal
Posted By HFHS M.D.-AK on April 17, 1999 at 12:28:29
Dear Peggy,
I think your doctor has done everything possible for you to avoid open kidney surgery.  The stone has to go, or your kidney will continue to be infected.  The fact that the pathway of drainage for your stone burden does not light-up on X-ray precludes the use of ureteroscopy.  The location in the upper pole makes it difficult for a PNL because of the risk of lung injury and bleeding.  I think your doctors are doing the right things for you, although I dont have the opportunity to look at your films to give you a third opinion.
I know I would worry about having surgery, but take comfort in the fact that open pyelolithotomy, the technical word for your procedure, is how we took stones out in the past.  These procedures are very successful and carry a low risk.  The most important reason this procedure has been replaced by PNL and ureteroscopy, is that today we can do surgery without putting a cut on a persons body(in most cases).
You can expect to be in the hospital for several days to a week after your surgery depending on your recovery.  You will most likely have a drain and a stent after surgery.  Your doctors can explain the specifics, but remember, this type of surgery has been performed many times with excellent results.
And of course we wish you good luck!
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:Renal Calculi











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