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Urology/hydroureteronephrosis and appendicitis

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Question
Hi, I am 32 year old male having severe right lower back pain since one day. Immediately I took ultrasound of abdomen, findings showed "very minimal right hydroureteronephrosis" and there is also other finding which shocked me. The finding showed as follows: "The appendex visualized at 11 'oclock position with a maximum diameter of 6.4 mm with thickening of walls and minimal periappendicular edema- ? recurrent." This finding shocked me since I don't have any stomach pain. I consulted 2 different doctors and they have given 2 different advises. One doctor suggested that my appendix is in bad condition so we need to do appendectomy immediately. And I took second opinion where the other doctor suggested that it is not acute condition since I am not having any pain related to appendix, so he suggested if there is any pain severely then only we can go for appendectomy.

I am confused whom to follow. Please advise what is exact diagnosis and treatment.

Answer
Shyam, let me begin by telling you that as a urologist, I have little expertise in the evaluation of ultrasound (US) findings related to the appendix.  For this, you should consult with a general surgeon.

As far as the pain in your right lower back is concerned, this coupled with the findings on US of "very minimal right hydroureteronephrosis" suggests that you might have a stone in the ureter partially blocking the right kidney.  However, such minimal findings on the US may just be technical error or another cause for the abnormality such as old scarring in that kidney from a prior infection.  The problem can be easily solved by obtaining a more exact imaging study such as a CT or  MRI of the abdomen or an IVP (intravenous pyelogram).  With urinary stones, microscopic blood will be present in the urine in over 95% of cases so a urinalysis is also recommended.  The CT or MRI would also give additional information on the questionable abnormality of the appendix seen on US.  Also, although kidney stones may cause low back pain, they are much more typically in the flank and radiate into the front of the lower abdomen and into the groin.

Again, a urinalysis and additional imaging study as mentioned above should resolve the diagnostic issues.  Good luck.

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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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