Resolved question:
Hello,
I was diagnosed on 5/9/14 with a 3x4mm kidney stone which at the time was at the mouth of the kidney to the ureter. At that point in time I was given nothing more than pain meds. Since then I have had several episodes of pain off and on. Usually lasting a few hours then I will be back to normal. Sometimes going weeks without any pain. I have currently gone two weeks without major pain. I can occasionally feel a twinge in my kidney or in my groin but it is minor and only lasts a few seconds/minutes. After waiting 7 weeks for an appointment I finally saw a urologist this past Monday. Before he even knew if I still had a kidney stone he was suggesting surgery to remove it. So he kind of seems very surgery happy which I am not excited about. He gave me the option of an ultrasound which I did. No stone was seen but there was reduce urine flow on that side. I demanded an x-ray which show the kidney is right above the bladder. He prescribed flomax which I have been on for 4 days now. I have read that it can take a couple of weeks for flomax to work. The flomax is making me very nauseous which the doctor is blaming on the stone instead of the meds because it isn't a typical side effect of flomax. But the nausea started when I started flomax and has been consistent since then. I feel better in the evening right before I need to take the next dose then absolutely awful when I wake up in the morning. I have also been drinking excessive amounts of fluids the past three days trying to flush it out, which is when the twinges in the kidney and groin started.
He says because it has been 8 weeks that it probably won't pass on its own, so he has scheduled me for surgery but I am wondering am I being rushed into it. Like I said before he seemed very surgery happy. Do I need surgery to remove the stone? Is it safe to wait longer to see if it passes naturally? How long is too long to wait? I am honestly quite nervous of the stent he wants to place as part of the surgery because I have read many horror stories about them from other patients, but also have read several medical journal articles saying they weren't necessary in uncomplicated procedures. One thing that is complicating things is I am heading out of town on vacation for two weeks so he is trying to get things done before I go. But I think I will be miserable with the stent on vacation. As I said earlier I am currently pain free except for the twinges, so would prefer to enjoy my vacation. Would it be safe to request not to have the stent even if I do need surgery? He keeps saying I could have complications while I am on vacation without the stent but from what I have read I could have complications with it as well. Some of the research studies even showed that people with stents showed up more frequently in the ER and other showed the opposite, so there seems to be no guarantee either way. I am not going to be in a remote area so there are hospitals available if needed.
I have had one other kidney stone 10 years ago, calcium oxcelate that passed in less than 24 hours with pain meds and fluids. I have honestly never had surgery for anything and would like to keep it that way. Bloodwork and urine analysis was all normal.
Any advice would be appreciated.
Submitted:
4 Days
Category:
Urologist
Thank you for your query at DoctorSpring.com.
Dear madam,
Your have a fairly good chance of passing out the stone. However, as it has been more than 8 weeks the chances have reduced from earlier, but still present.
In my opinion, you can go on vacation and continue Flomax for 2 weeks. You can undergo NCCT KUB(Non-Contrast CT KIdney, Ureters and Urinary Bladder), after 2 weeks procedure. Depending on the findings, you may need surgery and in that case require a stent too. Ureteral stents are functionally used to re-establish or maintain the patency of the ureter and you will require it to prevent complications such as ureteral obstruction following the procedure. Please do not worry about the complications because they are less frequent with proper positioning of the stent. Even if they occur, they can be effectively managed.
As far as the nausea is concerned, you can start yourself on Tablet. Pantoprazole 40 mg or Rabeprazole 20 mg or Ranitidine 150 mg, twice daily 30 mins before meals, till you are on Flomax.
Let me know if you have further queries.
Take care.
Sincerely,
Dr Rajiv Goel,
MS (AIIMS), MCh (AIIMS), DNB (Uro)
Fellow, Urooncology and Robotic urology, Australia
Fellow, Laparoscopic urology, Germany
Consultant Urologist.