Suggest treatment for severe abdominal pain and stone in ureteric pelvis

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Posted on Tue, 9 Jun 2015 in Urinary and Bladder Problems
Question: Hi !

this is Dr. XXXXXXX working in an insurance company. I have received a request for cystoureteroscopy with stone removal and stent insertion. The patient has presented with severe abdominal pain and a CT Scan was done showing a small stone of 3mm radio dense and at the lower pelvic segment of the right ureter. There is mild proximal right ureteric and right renal pelvicalcyceal system dilatation.

My question in this regard is that as per the symptoms and as per the CT Scan report an urgent intervention (cystoscopy) is required or we can manage the patient conservatively and wait till the stone is passed by itself, since the size of stone is so small that obstruction caused by the stone seems unlikely, yet no other reason could be found for the dilatation of mild proximal right ureteric and right renal pelvicalcyceal system dilatation.

Can you please guide us what management protocols to follow in such cases ?
doctor
Answered by Dr. P. T. Patil 2 hours later
Brief Answer:
Size of the stone is not significant .

Detailed Answer:
Hello
Thanks for your query.
After going through the report and the facts I would like to state that the size of the stone is not important to decide the mode of the treatment.

It is the edema at the site of impaction that causes dilatation of ureter and
pelvicalyceal system proximal to site of impaction .If left untreated a stone of a size of rice granule may lead to permanent damage to the kidney.

Generally following factors are taken in to consideration to decide whether one can expect stone to pass spontaneously without any treatment or to do immediate intervention by endoscopic removal of stone (Ureterorenoscopy)
1) Degree of Hydronephrosis
2) Recurrent attacks of severe pain
3) Vomiting .
4) Fever with rigors suggesting infection.

These four criteria are supposed to warrant immediate surgical intervention to save the kidney from further damage.

Hope I have answered your query ,please feel free to ask if you have more questions I shall be happy to help you
Thanks and Regards.
Dr.Patil

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. P. T. Patil

Urologist

Practicing since :1971

Answered : 10146 Questions

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