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Urology/Kidney stone - now in lower ureter

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Question
Dear Doctor,

Last month (@10th Oct), I had pain in my kidney and as I have had kidney stones problem 4-5 times in the past and every time they have been flushed out without any procedures by consuming lots of fluids, I knew it was the same problem again.

I went to a urologist who advised me CT with contrast.
This report mentioned presence of kidney stones (2 in right kidney, 1 in left- with the largest one measuring 7.2 mm in right Kidney).
The Doctor gave me medicines (Noculi, Urimax, Voveron, Dyter and Emset) and asked me to review with CT Scan after 2 weeks.

I got another CT scan done (without contrast this time) on 25th Oct and the report mentioned that the stone in left kidney was gone and the 2 stones in right kidney had “dropped down to ureter” and were “4 cm from  vesicouretric junction”.
The Urologist advised me to go for Meteroscopic stone removal (Lithoscopy) with stent.

However to take a second opinion, I went to another Urologist on 27th Oct. who changed my medicines to “Noculi syrup & Capsule Silodal 4 mg” and asked me to come back after 10 days.

I went back to him on 8th Nov – when he got an X Ray done – which still showed the 2 stones. The doc doubled medicine dosage to Silodal 8 mg & asked me to come with a CT scan on 20th – mentioning that if stones are still not out, then he will have to carry on the Lithoscopy procedure with stents.

I got a CT Scan done on 21st Nov and the report showed that there is just one stone of 7 mm now and that too at the junction of vesicouretric. There are no other stones in kidney and there is no swelling also.

When I took these reports to my Urologist, he said that we have given the stones enough time and as per medical practice, we should not wait more and carry out a procedure of Ureteric stone removal (by inserting telescopic tube and pulling stone out from penis). He said that any further delays may cause damage to my organs.
This all leaves me very confused.

If the stones are going down & are out of kidney – with no swelling etc in kidney & no pain for me, should I still go for this procedure or wait for more days for the last stone also to flush out?

That’s why I decided to seek your advise on this.

Answer
Vishal:

You've been fortunate in having most of the stones pass. You now have a 7 mm stone at the UVJ.  While the stones have been moving, there is little danger.  We typically like to give stones about 30 days or so to pass before recommending a surgery.  The 7 mm stone is now near the bladder.  In my view, I would give it the 30 days to either pass or not before recommending any new surgery.

You should talk to your physicians about 24 hour urine testing for kidney stone prevention analysis and therapy to help reduce your future risk of more stones.  Also, hopefully, you've recovered the stones you passed so they can be analyzed.

Urology

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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