Urology/stones

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Question
My husband had TURP almost 4 years ago.  He had burning regularly after dr couldn't explain.  After a year, he started seeing a diff doctor.  He was diagnosed with a slightly flaccid bladder.  About a year ago, he started suffering from stones.  He had two surgeries within 6 months to remove.  Finally, after more bleeding, more burning, and slowly the urine stream getting worse til he had to rely on cathing, his doctor suggests a vaporization of his high bladder neck, which he suspects is causing a pocket of urine which is producing stones.  During surgery (this Dec), he also finds a lot of scar tissue and the prostate is in the way.  He said it was like a maze to the bladder area, and now it is a clear shot and wide open.  After the cath removal, thankfully my husband improved a lot!  His stream was so good and over the next month or two he was able to hold his urine up to 4-5 hours at night, which is awesome.  His post void test both followups were under 30-35ccs
My concern is: he passed a stone about a month after surgery.  Dr said he could residual stone, blood, tissue, scabs etc for up to 3 months after.  Then he passed another stone about 2 months post surgery.  In the past 2 weeks though(approaching 3 months after surgery) he has passed 5 stones!  So far, they have just caused burning and when they pass the stream stops for a second, as opposed to before the symptoms were MUCH WORSE.  So far, they have yet to be too much of an issue, but WHY is he passing these stones? I understand that stones form when you are not emptying bladder and urine sits.  There is a straight shot now, he feels he is emptying, he can hold his urine much longer these days...why would there be stone issues still.  Could something ELSE be causing these stones?  Is there a test he needs done?

Answer
Elayna:

It is unclear where the stones are coming from.  A simple x-ray or KUB should be able to determine where the stones are.  Most stones that end up in the bladder come from the kidneys.  It would be unusual to form that many stones in the bladder although they can form in what's left of the prostate.

The stones can be analyzed which would help.  Calcium phosphate stones are typical of prostate related stones, while calcium oxalate is probably a stone that came from the kidneys.

Once this is clarified, we would be able to make some suggestions.

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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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