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Calculus in kidney, Is uretoscopy the best choice to remove it? Anxiety over painful stents

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I have an 11-mm nonobstructive calculus in lower pole in my kidney.My Dr. is using ureteroscopy to remove it. Do you think this is the best choice. Can all of the stone be removed at this time. I have also been told that stents are very painful. Getting anxiety over this . Your info will be greatly appreciated.
Posted Sun, 22 Apr 2012 in Kidney Conditions
 
 
Answered by Dr. Chandan Choudhary 10 hours later
Hi,
Thanks for posting your query.
The stone in the lower pole of your kidney can be removed by ESWL), percutaneous nephrolithotomy (PCNL) or retrograde intrarenaal surgery (RIRS). I personally prefer ESWL as a first line procedure and use PCNL, if it fails.
DJ stenting (a procedure to put a stent in the ureter) can cause pain but can be tolerated easily by most people.
As a semi-rigid ureteroscope can’t reach to lower pole of kidney, a flexible ureteroscope and laser will have to be used by your physician, if he wants to remove the stone ureteroscopically
I hope I have answered your query. I shall be available for follow up queries.
Regards.


Above answer was peer-reviewed by
 
Follow-up: Calculus in kidney, Is uretoscopy the best choice to remove it? Anxiety over painful stents 57 minutes later
DR. says ESWL wiil not work because stone is too large.I WOULD LIKE TO KNOW WHY URETEROSCOPY IS NOT AN OPTION. ALSO GOING HOME ON SAME DAY. WHAT PAIN MEDS ARE GIVEN. HOW LONG MUST STENT STAY IN.ARE YOU SAYING STONE CAN'T BE REMOVED WITH URETEROSCOPY.IS PAIN AS BAD AS KIDNEY STONE PAIN WITH STENT. WAS NOT TOLD ABOUT THIS.IS THIS A SAFE PROCEDURE.
 
 
Answered by Dr. Chandan Choudhary 2 hours later
Hi,
Thanks for writing back.
As we had already discussed earlier, the stone can be removed by flexible ureteroscopy and laser. But a semirigid ureteroscope is unable to reach in lower calyx stone. ESWL and PCNL are other options. Stenting is usually required for 2 to 4 weeks or until the whole of calculus is out. After the procedure, some antibiotics and painkillers like non steroidal anti-inflammatory drugs (like ibuprofen) are required for about 1-2 weeks. Stenting can cause pain in only few patients, so don’t worry
All the procedures mentioned above are very safe, if done by an experienced urologist but the safest is ESWL.

I hope I have answered your query.
Regards
Above answer was peer-reviewed by
 
Follow-up: Calculus in kidney, Is uretoscopy the best choice to remove it? Anxiety over painful stents 19 hours later
CAN STONES BE BROKEN INTO SMALL ENOUGH PIECESTO PASS THROUGH URETER.
AROUND WHAT SIZE WILL THEY BE. ALSO BECAUSE STONE IS LARGE WOULD YOU NEED THIS TO BE DONE AGAIN.DO YOU THINK I MIGHT HAVE TO STAY IN HOSPITAL RATHER THAN COME HOME ON SAME DAYI WOULD THINK YOU WOULD NEED SOMETHING STRONGER FOR STENT PAIN OR GO TO EMERGENCY . I WANT TO KNOW IF URTEROSCOPY WILL SOLVE MY PROBLEM. I REALLY DON'T WANT TO DO THIS AGAIN.DO YOU KNOW IF STONES WHEN BROKEN MIGHT BE NO LARGER THAN 4MM .IF THIS DOES NOT WORK WHAT IS THE NEXT OPTION.REMEMBER THIS IS IN THE KIDNEY AND NOT IN THE URETER.ALSO WHEN STENT TAKEN OUT IS THERE STILL STONES IN URETER. THANK YOU FOR LISTENING TO ME JUST HAVING ANXIETY OVER THIS JUST WANT IT OVER WITH. AGAIN THANK YOU SO MUCH
 
 
Answered by Dr. Chandan Choudhary 1 hour later
Hi and thanks again,

I can understand your concern and I am sorry if my answers weren’t helpful in alleviating your fears and anxiety about the procedure. Let me try again by giving you a detailed account of the treatment which I hope will clear all your doubts.

1. Renal stones can occur of various size, types and shape. Clinically any stone less than 10mm of size have better chances of coming out on its own. Stones above 10mm may need to be removed. Modern improvements in the treatment allow a surgeon to treat stones above 10mm with wide variety of treatment.

As a XXXXXXX Consultant Urologist, I have handled all the procedures in more than thousand patients. A few commonly performed procedures are:

a) Extracorporal Shock Wave lithotripsy (ESWL) – This uses shock waves to break the renal stones into small ones to pass through the ureter. We can break stones upto 1.5 cm in size or sometimes bigger than that with ESWL. Rarely sometimes when the stone fragments do not pass away after being broken down by ESWL, we may repeat the procedure or perform ureteroscopy which ever is best suitable.
As you mentioned that your stone size is 1.1 cm in size and is in the lower pole of kidney, this can be managed by easily by ESWL and stenting.

ESWL can be performed as an outpatient procedure where you can go home by an hour following it.

b) Ureteroscopy can be tried to remove stones in the kidney such as the ones in you with ONLY FLEXIBLE URETEROSCOPE AND LASER. Ureteroscope is the instrument used to perform the procedure. Routine scopes that are rigid or semirigid, I am afraid might not pick up the stones located in the kidney unless they have moved down now. Further, it is usually a daunting challenge to pick up stones in kidney using an ureteroscope.

As far as stay in the hospital is concerned, you may need to stay for a day or two following ureteroscopy.

c)Other options available to treat stones in kidney are percutaneous nephrolithotomy or retrograde intrarenal surgery. These procedures again need hospitalization for 24 – 72 hours.

2. All the treatment available have been useful in treating the current stone. Medications, increased fluid consumption and lifestyle measures are necessary to prevent recurrence of such condition.

I understand that you do not wish to have this problem again. Hence you will need a strict lifestyle consisting of healthy diet and proper hydration to keep yourself off recurring stones.

3. Based on the details provided, I am not aware of any reason of not trying ESWL on you. As ESWL is less invasive, more flexible than ureterscopy and needs no hospitalization, I would prefer to treat you by ESWL if I were to be your treating doctor.

Hope this is clear now. Let me know if I have missed out on any concern. Do accept the answer if you do not have any further queries.

Wish you good health.

Best wishes
Above answer was peer-reviewed by
 
Follow-up: Calculus in kidney, Is uretoscopy the best choice to remove it? Anxiety over painful stents 11 hours later
SORRY TO BOTHER YOU AGAIN. I WAS TOLD 1/2 INCH IS TOO LG. FOR ESWL COULD NOT BREAK SMALL ENOUGH. ALL I REALLY WANT TO KNOW IS DO YOU THINK THIS PROCEDURE WILL HAVE TO BE DONE AGAIN.HOW PAINFUL IS STENT.WHEN REMOVED IS THERE STILL STONES INURETER. THANK FOR PUTTING UP WITH ME
 
 
Answered by Dr. Chandan Choudhary 11 hours later
Hi,
I understand your concern.
As I had explained earlier, ESWL can be used for stones which are about half an inch in size. Whether the procedure would need to be repeated or not can be determined after assessing the response to the first procedure.
Further, even though stents are slightly painful, the pain can be easily tolerated. The pain will not affect your quality of life.

I would like to reassure you that everything will be fine.

Please accept my answer if you have no follow up queries.
Regards.
Above answer was peer-reviewed by
 
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