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Treatment To Remove Big Kidney Stone

Posted on Fri, 24 Jan 2014

Question: Last week I was very sick with nausea and jabbing pains in my right upper quadrant. I thought it was my gallbladder, but when I went to the ER, the xray showed it was a 9mm kidney stone. The ER doctor told me it was probably too big to pass, but I should have it removed. He referred me to a urologist, whom I saw yesterday. The new xray shows that the stone has worked its way into the ureter. The urologist chose to treat it with Tramsulosin. He explained that it could have trouble passing from the ureter into the bladder because of its size, but we would "deal with that if and when the time comes." In the meantime, I am not in excrutiating pain, just some jabbing pain here and there. I don't have a fever but I am a little bit nauseated and I am exhausted. The doctor said this stone could take a month to pass. I don't want to feel this way for a month, plus, I have been very anxious since I talked to the doctor because my husband had a kidney stone and it was not a pretty sight. My question is whether or not it would be appropriate (and medically sound) to ask the doctor to just go ahead and remove the stone so I can start feeling well again and get on with my life; plus I don't want to always worry about having problems passing this thing like my husband did.

Answered by Dr. Dr. P. T. Patil (50 minutes later)

Brief Answer: You can undergo Ureterorenoscopy(URS) Detailed Answer: Hello Thanks for your query,based on the facts that you have posted it appears that you had a stone in the Right Kidney which has moved down in to Ureter. I shall be happy if you can post me few more details to help me in making comments on your problem. 1) What is the location of stone at present whether in upper ureter or lower down.? 2) Have you done ultrasound scanning of the abdomen and are there obstructive changes in kidney and ureter proximal to stone (Hydronephrosis) ? 3) Have you done Intra Venous Pyelography to assess function of both the kidneys ? I do agree that the stone of size of 9 mm will pass down with much difficulty and will take long time to pass through. You can discuss with your Urologist about endoscopic fragmentation of stone with lesser energy or lithotripsy what is called as Uretero Renoscopy (URS) . 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

Follow up: Dr. Dr. P. T. Patil (6 minutes later)

The stone is in the upper part of the ureter; the doctor said it was in the upper third. I had a regular xray of the abdomen done in the ER, which showed the stone. The urologist did not order any additional tests. Is there any medical advantage to letting the stone pass on its own rather than doing the procedure you mentioned?

Answered by Dr. Dr. P. T. Patil (22 minutes later)

Brief Answer: You need to do ultrasound scanning . Detailed Answer: Hello Thanks for follow up. You need to get Ultrasound scanning of the abdomen to see whether there are any obstructive changes in kidney and ureter proximal to stone. If there is no pain the stone in upper ureter is left alone and any endoscopic intervention is done once it comes down .The advantage of medical treatment over endoscopy is that you do not have to get admitted in hospital and anaesthesia is avoided . However if stone gets impacted in lower ureter and gives rise to symptoms like vomiting ,severe pain ,fever you have to get it treated with URS with fragmentation as I have mentioned earlier. Thanks and Regards. Dr.Patil.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar