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Sonography done. Found liver cyst and kidney stone. What should be done to remove this?

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Hello Doc,
This query is about my mother. She is 51 years old. Recently she has done her sonography on 16.04.2013. It says the following:
1. A 3 x 3 cm sized thin wall simple cyst is in left lobe of the liver.
2. The gall bladder is collapsed and shows a calculus 10.3 mm. There is no pericholecystic fluid. The CBD is normal in course and caliber.
3. Both Kidneys are normal in size, shape and parenchymal echogenecity. In the right kidney, a 8mm calculus is seen in the upper pole calyx. There is no hydronephrosis.
In the left kidney, a claculus measuring 18mm in the lower pole calyx. There is no hydronephrosis.
Rest everything in the report says normal.
However I am very concerned regarding the kidney stones which is bigger in size now. Please advice if these can be removed without open surgery or if can be done with laproscopy or it is fine not to remove them?
Also please advice regarding the liver cyst and also regarding the gall bladder stone.
I am currently out of country for work. I will be back home next month, so I am planning to remove these stones then. However I need your honest advice regarding the same at present. Eagerly waiting on your response.
Thank You
Posted Tue, 14 May 2013 in Urinary and Bladder Problems
Answered by Dr. V. Sasanka 48 minutes later
What you have said is true- the size of the kidney stones is certainly worth consideration, especially the one on the left measuring 18 mm. This will continue to grow and cause trouble unless removed, while there is a small possibility the the right renal calculus might not require treatment and pass out on its own being about 8 mm and located in the upper calyx. What we would like is an understanding of the anatomy and function of the kidneys, and how hard the stone is, by means of tests called IVP or CT KUB which will also help plan how we do the treatment, i.e. by means of endoscope or through a mechanism called shock waves.
I am fairly certain that the liver cyst will not require treatment, (but the gastroenterologist will give the final opinion regarding this) while the gall bladder stone will eventually require a surgery by means of laparoscopy. Whether we can combine the gall bladder surgery with the kidney stone procedure also needs to be planned based on how we approach the kidney stone. I doubt if we can do laparoscopic gall bladder removal with an endoscopic 'percutaneous ' removal of the kidney stone because of logistical difficulties in positioning of the patient. A Stenting of the left kidney followed by shock wave lithotripsy or with Holmium Laser lithotripsy can be combined with gall bladder removal but the chances of stone clearance are poorer in view of location of stone (lower pole) and larger size(18 mm). So eventually your might require two procedures. Both of these are technically major procedures in the sense your mother will require general anaesthesia, and therefore her general health should be thoroughly assessed before she is taken up for these surgeries, and can be done in a multi-specialty hospital.
Hope I have been able to help you.
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