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Urology/8 mm Stone in Right Kidney

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Question
Sir,
I am AMIT, male 25 year old from India. I have a stone 8mm in my right kidney.
3 months earlier I found the pain in my left kidney, so I have concerned a doctor and ultrasound then found 8 mm stone in my right kidney. But pain occurred in the left kidney and stone found in right kidney.

Again after 2 months randomly pain starts in my right kidney and testis. So doctor gave me two injection and some meditation like URIKIND and NORFLOX etc. Injection name is not remember me. After injecting the injection the pain goes under 20 mins. But in the night I have intercouse then starngely it was dry oragasm, no semen come out from my penis. So I am very worried about this, This is done first time with dry oragasm. So please answer my question I am waiting for this.

Answer
Amit, so called "dry" orgasm, was most likely due to retrograde ejaculation, probably a side effect of the medication injected.  Without the name of this drug I cannot be sure but I suspect this will be a one time event.     During sexual arousal the prostate gland & seminal vesicles manufactures fluid that account for the majority of the semen. The seminal vesicles are paired structures located behind the prostate gland that are also sensitive to sexual excitement.  Sperm from the testicles (which account for only 1-2 % of the semen) travel up a series of tubes (epididymis and vas deferens) on each side to join the seminal vesicles forming the paired ejaculatory ducts.  These structures empty into the prostatic portion of the urethra.  At the time of ejaculation, fluid is discharged from the prostate gland and ejaculatory ducts into the urethra (urinary canal) forming the semen.  The average semen volume is 2-6 cc.  With the inception of ejaculation, the bladder neck closes and the semen is forced forward out the urethra by contraction of the pelvic muscles.

Retrograde ejaculation occurs when the bladder neck does not close  at the initiation of ejaculation.  This results in semen taking the path of least resistance which is backward into the bladder rather than forward out the urethra. The diagnosis is made by a typical history and the finding of sperm in the first voided urine specimen after orgasm & ejaculation.  This can be congenital or acquired.  Most often is due to malfunction of the pelvic nerves that stimulate closure of the bladder neck.  Common causes of this are pelvic surgical damage and certain diseases of the nervous system such as diabetes, multiple sclerosis & spinal injuries.  Certain medications (such as those used for high blood pressure and emotional problems) may also produce this side effect.  In your instance, I suspect this was a one time event related to the injected medication.   The diagnosis is made by examination of the first voided urine specimen obtained after ejaculation.  The presence of semen elements, namely sperm, on examination of the urine clinches the diagnosis.  If a recurrent, a urologist can evaluate this further for you - but again, I think it is unlikely to be a repeated problem.

And now, a few comments about your kidney stone pain.  Your kidney is made essentially of 2 portions:  the parenchyma and the pelvo-calyceal system. The renal parenchyma is the outer meaty portion of the kidney which is constructed mainly of millions of tiny tubules that filter waste products from the blood for excretion in the form of urine.  The interior of the kidney is a lined collecting cavity called the pelvo-calyceal into which the parenchymal tubules drain the urine.  It is here in the pelvo-calyceal system that stones form.  They usually lie free but on occasion may be attached.  Stones that are in the kidney generally are painless.  It is when they move out of the kidney causing either blockage of urine drainage or muscle spasm in the ureter (the tube that drain urine from the kidney to the bladder) that pain occurs. If the stone becomes lodged in the lower ureter, it characteristically causing irritation of the urinary bladder producing marked urinary frequency and urgency.  Typically, this pain is unilateral, starts  in the flank, radiates into the lower abdomen and then into the ipsilateral testicle.  The pain may be constant or intermittent, mild or severe but more often the latter.  As the stone scrapes the lining of the urinary tract, blood in the urine is often noted.  Movement of stones are spontaneous and may occur during activity, rest or sleep.  Passage is unrelated to physical activity.

Imaging studies (usually an IVP or MRI) are needed to definitively diagnose urinary stones.  The degree of obstruction, location and size of the stone all are factors in determining the likelihood of passage and treatment options.  The latter includes conservatism (forcing fluids and taking pain medication as needed), extracorporeal shock wave lithotripsy (ESWL), endoscopic manipulation or, less commonly, open surgical removal.  Intractable pain, severe kidney obstruction or signs of sepsis (fever, chills) are indications for prompt intervention.  

In your particular case, I suspect you passed a small stone or gravel from the left kidney.  The stone in the right kidney is causing intermittent blockage and pain or it may have since moved into the ureter.  Statistically, stone greater than 5 mm rarely pass on their own.  Of the options for treatment available, I would suggest ESWL.  Again, you should discuss treatment with your urologist as your pain is recurrent and the likelihood of an 8 mm stone passing spontaneously is small.  Good luck.

ADDENDUM:  Of the medications you are taking orally, one is an antispasmodic and the other an antibiotic.  These will not cause retrograde ejaculation.  You should have some pain medication on hand should the discomfort recur before your stone is treated.

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Arthur Goldstein, M.D.

Expertise

Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.

Experience

I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

Organizations
American Medical Association, American Urological Association, American College of Surgeons

Education/Credentials
College degree - BS Medical degree - MD Master of Science - MS

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