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Suggest Treatment To Remove Stone In Ureter
Question: My grandfather is around 82 years. He was diagnosed with gall bladder stone some 5 years ago which was not a problem for him at that time. Nowadays, it has started giving problems like chest pain, disturbed sleeping, one sided sleeping, less hunger, etc.. When diagnosed again for some of the tests suggested by local doctors, the stone size is now significant and is now about 11.9mm, other tests are not a worry. I have two questions: whether he should be going under surgery or take some medicines at home to get relieved? Second, because he is not very much comfortable with surgeries, which medicines he might try to begin with? Is AIMIL NEERI syrup good for gall bladder stones? The position of this gall bladder stone is somewhat in the ureter. PFA the reports.
Brief Answer:
Immediate hospitalisation needed
Detailed Answer:
Hi, thanks for posting your concern in the HCM. I checked the reports.
I think you should immediately hospitalise him. He doesn't have any gall stone. He has stone in his ureter, which is the outlet for urine from kidney to bladder. The ureter has got obstructed and there is back pressure of the urine that has been causing dilation of the part of the ureter proximal to or above the obstruction resulting in hydroureter. The function of renal parenchyma has also been significantly compromised because of the back pressure. Hence, renal failure has started which was reflected by raised urea and creatinine levels. That has also precipitated dyselectrolytemia with high potassium, which is very common in chronic kidney disease. Therefore, this condition is an emergency and immediate hospitalisation under care of a urosurgeon is needed. Drainage of the accumulated urine and removal of the stone, after correction of dyselectrolytemia and infection, if any is urgently needed. I hope you understand the gravity of the situation now. So, please don't delay.
To answer your question the need for surgery cannot be said without examination and knowing the general condition.
And secondly, I don't think a home based care with some oral medications like AIMIL XXXXXXX only can really be a rational choice at this point of time.
I hope you are satisfied with my answer. If you don't have a further question, please close the thread and rate my answer.
Regards,
Dr. Kaushik
Immediate hospitalisation needed
Detailed Answer:
Hi, thanks for posting your concern in the HCM. I checked the reports.
I think you should immediately hospitalise him. He doesn't have any gall stone. He has stone in his ureter, which is the outlet for urine from kidney to bladder. The ureter has got obstructed and there is back pressure of the urine that has been causing dilation of the part of the ureter proximal to or above the obstruction resulting in hydroureter. The function of renal parenchyma has also been significantly compromised because of the back pressure. Hence, renal failure has started which was reflected by raised urea and creatinine levels. That has also precipitated dyselectrolytemia with high potassium, which is very common in chronic kidney disease. Therefore, this condition is an emergency and immediate hospitalisation under care of a urosurgeon is needed. Drainage of the accumulated urine and removal of the stone, after correction of dyselectrolytemia and infection, if any is urgently needed. I hope you understand the gravity of the situation now. So, please don't delay.
To answer your question the need for surgery cannot be said without examination and knowing the general condition.
And secondly, I don't think a home based care with some oral medications like AIMIL XXXXXXX only can really be a rational choice at this point of time.
I hope you are satisfied with my answer. If you don't have a further question, please close the thread and rate my answer.
Regards,
Dr. Kaushik
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your response. Out of the available methods for this surgery, which one might be good one seeing his age, is ESWL a good solution at this part of time? Or some other method of surgery?
Also, can you please suggest me the best urosurgeon in Ajmer/Jaipur cities in XXXXXXX or XXXXXXX if you have info about this?
Also, can you please suggest me the best urosurgeon in Ajmer/Jaipur cities in XXXXXXX or XXXXXXX if you have info about this?
Brief Answer:
Detailed answer below
Detailed Answer:
Hi XXXX, thanks for writing again.
1. I don't think ESWL can be the surgery of choice in this regard. Your father has already got obstructive uropathy and consequent nephropathy and therefore, as I have written in the previous post, drainage surgery is required. But, also the decision can be best taken by a consultant urosurgeon.
2. Drainage of the part of the ureter above the site of obstruction, along with surgical revision, stone removal and plastic repair should be done. The ideal method can be best judged by the Urosurgeon considering the risk-benefit ratio pooled for this age. If the condition of the patient is unstable, particularly at this point of time, and long surgical procedure becomes very risky considering the age and current condition of the patient, ureteral stenting may be done to relief the obstruction and save the patient,
Whatever may be the surgical procedure, the patient should first be stabilized by correcting electrolyte imbalance and/or infection.
3. I don't have much knowledge regarding XXXXXXX or XXXXXXX However, there are several renowned medical colleges both in XXXXXXX (e.g. SMSMC, Jaipur) and XXXXXXX (e.g. XXXXXXX MAMC etc.). You can visit the OPD of Dept of Urology there and I think the faculties of the Urology Dept. of these Medical Colleges are definitely very good and also, in a medical college, decision regarding any treatment is taken by an entire unit and not by an individual doctor. So, the decision is more rational.
Hope you are satisfied with my answer. If you don't have any further questions, please close the thread and rate my answer.
Regards,
Dr. Kaushik
Detailed answer below
Detailed Answer:
Hi XXXX, thanks for writing again.
1. I don't think ESWL can be the surgery of choice in this regard. Your father has already got obstructive uropathy and consequent nephropathy and therefore, as I have written in the previous post, drainage surgery is required. But, also the decision can be best taken by a consultant urosurgeon.
2. Drainage of the part of the ureter above the site of obstruction, along with surgical revision, stone removal and plastic repair should be done. The ideal method can be best judged by the Urosurgeon considering the risk-benefit ratio pooled for this age. If the condition of the patient is unstable, particularly at this point of time, and long surgical procedure becomes very risky considering the age and current condition of the patient, ureteral stenting may be done to relief the obstruction and save the patient,
Whatever may be the surgical procedure, the patient should first be stabilized by correcting electrolyte imbalance and/or infection.
3. I don't have much knowledge regarding XXXXXXX or XXXXXXX However, there are several renowned medical colleges both in XXXXXXX (e.g. SMSMC, Jaipur) and XXXXXXX (e.g. XXXXXXX MAMC etc.). You can visit the OPD of Dept of Urology there and I think the faculties of the Urology Dept. of these Medical Colleges are definitely very good and also, in a medical college, decision regarding any treatment is taken by an entire unit and not by an individual doctor. So, the decision is more rational.
Hope you are satisfied with my answer. If you don't have any further questions, please close the thread and rate my answer.
Regards,
Dr. Kaushik
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Above answer was peer-reviewed by :
Dr. Prasad
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