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Urology/Kidney small calculi at ureter

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QUESTION: Around 3-months back, two times severe pain felt with intermittent gap of 15mins approx. After 8 days to that, haematuria happened which lasts 4 days on downward trend. Doctor examine with USG and USG result said as dilated (light swelling ) at left kidney ureter passage and thus it is understood that it might had due to passing of small stone. No pain during haematuria and afterwards. No pain / nothing else till now. Before two days it was identified that residue effect in left kidney is still persisting; so CT Scan been done and it resulted as two small calculi at left ureter (3.5mm & 2mm) are there.  Urologist advice to remove it by surgical approach saying stone stayed for more than 2.5months so it may not come by other way. Later later on my request & situation of delayed availability of any guardian/friend with me in city takes around 10days; medicine dynapres 0.4mg & drotin are prescribed for 10 days. Can you help to understand above situation why stone of such small sizes with no pain would haven't a few possibility of coming out with medicines.

ANSWER: Sandeep

Stones that are less than 4 millimeters in size have a 90% chance of passing on the road once into your order. However, if such stones failed to pass within 4 to 6 weeks surgery is usually recommended to avoid complications such a scarring and persistent pain. in many cases we will also recommend 24 hour urine collection is to identify the underlying causes that are creating the stones so they can be treated with diet or medications to minimize future stone production. You should talk to your doctor about these options.

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QUESTION: Thank a lot for quick & valued reply. Please provide your opinion for following also:
1.What are the chances there to get small stones out with Medicine (Dynapres 0.4mg & drotin) at present situation?
2. It needs to Cure by surgery procedure if these stones appears again in another CT scan to be taken after 10 days medicines. Doctor told that a insertion is put up during first surgical procedure (in both cases whether small stones get out in first attempt or for enlarging  ureter tube so that stone may be made out in second attempt after 4weeks) and this insertion will be put after 4 week I.e. during second attempt. Anesthesia given during first attempt at waist and local anesthesia at local (urine outlet) during second attempt in case where stone is traumatised at first attemp; and otherwise anesthesia at waist given both times.  How much the anesthesia role is critical here ?
* Both producers are not mote than 24hr hospitalisation and home rest may be required around 2-4days.

ANSWER: Sandeep

These are questions you need to ask your surgeon as the answers depend on the exact location, size, shape and consistency of the stones as well as the particular surgical procedure selected.

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QUESTION: Attaching CT Report. .its at Left UVJ. 2 & 3.5mm; however doctor suspected it may haven't single in trapezoidal Shap as CT shows slice at 3mm gap. Both small small stones appeared at neighbouring slices. Will medication not fragment /break it  an dc force to out? Should we try first mentioned medicines for next 10days and later see again what comes in CT? My Doctor was suggesting for ureteroscopy instead medication at first.

Answer
Sandeep

We do not give specific medical advice on this forum. However, in general, stones smaller than 5 mm will probably pass on their own. This is more likely if the stones arrive close to the bladder. Medications like tamsulosin can help them pass but there us no medication that will break them up with a few exceptions such as uric acid stones.

In most asymptomatic cases such as you describe, it is reasonable to wait and see if the stones will pass. If not, then surgery is reasonable.

In your cae, I would suggest you get a second opinion from another urologist.

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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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