FAQs

Stone Disease

The ureters are actually quite thin, but they are pretty good at propelling urine down toward the bladder with peristalsis. Even a small stone can cause pain, which is from intermittent obstruction caused by the stone as it haltingly works its way down. There is a very good chance you will pass that stone without a surgery, but it may take a while. A small percentage of little stones (3 to 5 mm) get stuck in the ureter and require surgical treatment of some kind. The pain is caused by swelling of the kidney as the stone gets stuck and the urine backs up. Your urologist is probably expecting you to wait for a period of time and then followup – make sure you do that even if you pass the stone.

Category: Stone Disease

Ureteroscopy is done to inspect the ureter, which is the tube that drains the bladder to the kidney. This is done using either a rigid or a flexible scope, depending on what the purpose of the procedure is and how far up the ureter the work is done. Most ureteroscopies are done for removing stones from the ureter or kidney. Others are done for diagnostic purposes such as biopsies. Some are done just to monitor a patient with ureteral or bladder cancer. 

Benefits of ureteroscopy are that it is an excellent way to clear ureteral stones and small kidney stones. It allows visual inspection of the ureter and kidney in a way not possible with radiologic procedures. Strictures and other injuries of the ureter can be inspected and in cases where it is needed, biopsies can be done. Laser fibers and stone baskets can be passed through the scopes permitting lithotripsy and stone basket extraction of stones. 

The risks of ureteroscopy are in addition to the risks of cystoscopy. In passing an instrument through the ureteral orifice and into the ureter, this opeing in the bladder can be torn or stretched. The ureter can be torn from the kidney or the bladder, and it can be torn open in the middle. If this happens and the problem is minor, a stent can be left while the ureter heals. Sometimes the injury can be extensive enough that open surgery could be required to repair the ureter. Sometimes the ureter is obstructed by stones or cancer and ureteroscopy fails to open a path for the kidney to drain. In this case a referral to a radiologist that day would be made for placement of a nephrostomy tube to drain the kidney directly. Every surgery has risks of acute or chronic pain, infection and bleeding – this one is no different. Blood may be seen in the urine for a while after ureteroscopy. A stent may need to be placed in the ureter at the end of the procedure, and this can cause discomfort and mild bleeding too. Strictures that narrow the ureter can occur weeks to years after ureteroscopy. 

Risks are managed with careful attention to detail during surgery, and appropriate antibiotics and medications afterwards. The problems of ureteroscopy do not surface often, but it is best to be prepared prior to moving ahead with this procedure. If a thousand procedures are done, some of these complications will occur to a few people because everyone and every situation is slightly different and some procedures are very technically difficult.

Category: Stone Disease

Maybe so, maybe not. Usually the advice when trying to pass a stone is to urinate into a strainer, so that you can see the stone(s) when they pass out the urethra. If you don’t use a strainer you might not see or feel small pieces. Sometimes a person who has a stone and is in a lot of pain eventually stops having pain. The pain is caused by swelling of the kidney by the urine as it backs up behind the stone. Eventually the pain can subside, even if the stone has not passed. The kidney in this situation is not able to drain urine, and it slowly starts to lose function. After a few months it can stop working altogether. It is very important to get a checkup and have the appropriate imaging studies to make sure that there is no urinary obstruction even if the pain has gone away when trying to pass a stone.

Category: Stone Disease

If you are passing multiple small stones it is possible that you have a larger problem. For one you might have a tendency to form stones that can be treated. Also you could have obstruction of parts of the urinary system. Obstruction that arises slowly is not always painful. Go see your urologist; make sure nothing worse is going on. If you don’t understand the underlying cause or don’t know the extent of the problem, you could do yourself harm.

Category: Stone Disease

The basic problem is that the kidneys are releasing more minerals than the urine can hold in concentration. The chemistry is complex, but the root of the problem is that the urine is precipitating crystal. The kind of crystal varies with the amount of minerals excreted by the kidney, the pH of the urine, and other factors. That is why drinking a lot of water to make the urine more dilute is the first step to preventing stones in the urinary tract.

Category: Stone Disease

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