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    How can severe pain when diagnosed with kidney stones be managed?

Posted on Wed, 12 Jul 2017 in Urinary and Bladder Problems
Question: In last 6 months twice kidney stones got flushed out (4+1 stones). I was taking advice from Urologist in XXXXXXX Even after flushing out stones, on &off i am feeling very mild pain in left side. Hence, i have visited Dr.Bejoy XXXXXXX in Kokilaben Dhirubhai Ambani Hospital, XXXXXXX After listening to my history and look at old reports including attached MRI Urogram report, he said it is due to Caliceal Diverticulum in which still there will be some stones. As per him, this is kind of congenital abnormality in left kidney due to which stones got formed (Milk of calcium) and this is not something like people having stones randomly. Also, he said it is symptomatic. But if required, can go for surgery . Now wanted to know, severity of the issue, how many stones might still inside, line of treatment, whether surgery is mandate and which type of surgery is best even if cost is more, whether current condition can lead to complications? Please advise, as i am totally blank now. Off course, planning to repeat MRI Urogram asap (last done in 2009). I need your help. Thanks in advance.
Answered by Dr. Matthew J. Mangat 3 hours later
Brief Answer:
Send the MRU also.

Detailed Answer:
Hello XXXXXXX and welcome to HCM.
As an Urologist, I can understand your concern.

You've left kidney calyceal diverticuli with stones and multiple ureteric strictures.
The kidney diverticuli are by birth. The stones in them need to be removed.
The ureteric strictures are multiple and need to be addressed for further evaluation. They can be problematic, as it can affect kidney function.
I'll give the opinion after seeing the scan.
Kindly send the scan and reports of all tests done so far.
Wish you well.
Dr. Matthew J. Mangat.
Above answer was peer-reviewed by : Dr. Kampana
Follow up: Dr. Matthew J. Mangat 26 minutes later
Dear Sir, Thanks for the revert. I have already attached the MRI Urogram done in 2009. Since 2009, didnt had any issues of blockage. My urologist said, passage is now very clear. How to remove the stones? How to correct the calyceal diverticuli? You mean to say these stones formed over a period of last 36 years since my birth and started coming out one by one. Is there any chance to still form in the same area on ongoing basis. What need to be done to get rid of this permanently. Please advise
Answered by Dr. Matthew J. Mangat 5 hours later
Brief Answer:
MRU and other reports not yet sent. Repeat the MRU.

Detailed Answer:

It's essential for us to co-relate the Urogram( MRU ), with the report.
Your initial query had only the report.
Hope you've understood why the MRU is essential for a viewing.

Your three queries are :
1. Is the calyceal diverticulum formed at birth.(congenital).
2. Will stones continue to form in it ?
3. Is there permanent treatment.

1. Calyceal diverticulum is a congenital condition.
Stones forming inside this,need to be removed,as it can cause infection.
At the same time,the calyceal diverticulum can be treated.
The treatment is done by an endoscopic surgery,called PCNL or RIRS(laser).
The stones you passed,were from the kidney,but outside the diverticulum.
i.e. outside of the diverticulum,but in the kidney draining tube.

2. If this treatment isn't done, stones can form in the diverticula.
That's the reason,Dr.Bijoy advised you to undergo the surgery.

3. The above treatment is a permanent cure for the diverticulum.

Remember,you also have another problem,that will affect the kidney function.
That's the multiple ureteric strictures. (x 3).

This should be the cause for your flank pain.
As the '09 MRU has not been sent,and none of the reports done so far,
you're advised to repeat the MRU and send the two scans here,for an expert opinion.

Wish you well.
Dr.Matthew J. Mangat.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Matthew J. Mangat


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