Kidney Stones

[Uro-Greif]

Since 06/09/07 I have wrestled with a 2.5CM Stone a stent was placed on 10/31/07 to ease the task of passing a laser blasted 2.5CM Stone
After100's of sandy slivers and even glass fragments from the laser's distal end...Having had several stones in the past i felt that this wasn't normal pain with me complaining for more meds...on 12 /18/07 the pain was so bad that i called for re-assurance only with my Doc saying NO to the meds and yes to another kub to see if i even needed the stent...still had stones...I told him i wasnt able to do my part as much as i needed to be doing because of the pain..still no meds...
on 01/03/08 I passed KIDNEY TISSUE (that either didn't or couldn't be seen on KUB) this mass about 2 inches long with the appearance of a cooked noodle in size and color...the pain of passing this was as bad as i have ever felt and for one of us to say that you can imagine!!! needless to say i was concerned about my kidney being damaged so i called my Doc and his Nurse says as long as im whizzing "no worries" and be certain to keep IT ...next day i felt as if i was whizzing hot razors(no meds) so again i called...they said come in he would FIT me in ....He was irate to say the least ask me "WHAT DO YOU WANT?" I handed him a 8 x 12 glossy of this mass and asked him if i should be concerned..to my amazement he said he didn't know what it was and said my stent was to be at fault and that i should have known that this would happen...this is my second stent and if stents do this why did he say he did not know what it is? here it is 4 days since the mass came out and this morning i have passed 3 stones 1 mm to 2 mm in size and three stones between 3mm-5mm..6 stones all within 2 hours and no meds... I finally started feeling human...next becomes the stent pull in which i have asked to be put out because of the first pull going so bad in 09/04...
Good Luck to everyone,Bruce 49/M 25yr sufferer and if i may end on this... if your doctor hasn't had a stone...He or She don't realized how much we are in touch with our system...
while i was proof-reading this i passed another 2mm stone... 7 stones all behind that tissue mass from the laser fiber-optics breaking and cutting my kidney..NO WAIT Doc said it was my stent...Has YOUR stent ever made you pass tissue or do i have a special one?

[mctripat]

I have recently had 3 utererscopies and thus 3 stents. I have never seen kidney tissue that I may have passed. If you have kidney stone/ kidney pain and think your doctor is not treating the pain you should find another doctor. There are state and federal laws and professional ethics all about pain management. I would report the urologist to the state medical board. He is not doing the profession any favors.

Here is my story about no pain management:(following a kidney stone procedure 4 days before)

Kidney stones can be passed up to around 3 weeks after a procedure. I began to pass stones on Nov 20 after, Nov 1 utererscopy. I also passed stones about 19 days after Sept 20, utererscopy. Doctors are unable to predict( after ESWL, utererscopy and PCNL) who will pass stones, when it will happen, how much pain you will be in, will an er visit or hospital admission be needed etc. This is considered a normal complication of the kidney stone treatment and er visits are not unususal.

I had to report the hospital I went to for pain management... because on Nov 5 Sat I had to go to the er. I called an ambulance to go there. I have to go to the county hospital/university medical center level 1 trauma center.... place were all the uninsured people have to be treated because my doctor works there. He is a professor at the medical school and trains a lot of residents. I have never gone to a hospital er room with a kidney stone attack in an ambulance before... and I have had a lot of attacks since 1965.

I got a bit of morphine in the ambulance and a touch more after being triaged. I was sent out to the front of the waiting room to wait for the urology resident on call.... this was around 4:30 pm and he was probably doing rounds. However, doctors get paged while they are doing rounds and can go down to the er... There was a paramedic who was the gatekeeper and I was told I was to wait for the resident for 5 maybe 8 hours with no more pain medication. Since my demoral and morphine had worn off my pain was back up to a 9. Well I had a meltdown and said " do you think I am inviting people to a picnic, I am having a kidney stone attack" and gave them 30 min to do something. They continued to ignore me so they took out IV and I left.

I have health insurance so I went to a hospital that is connected to my usual medical center. After seeing the other er I knew all ers in town would be full of sick people. I still had to wait over an hour to be seen plus it took an hour to drive there but, my pain lessened gradually to maybe a 5 or 6.
I was given torodol for the pain and laid on the gurney for an hour. That drug is in the ibuprofen family it is a NASID so morphine, demoral or oxycontin can be used with it .

I complained to one of the head doctors at the school of emergency medicine in December. The school of emergency medicine does the administration for the er... I could sue the hospital for this but
my doctor is a wonderful doctor and the residents are good doctors also and I need more treatment... more utererscopies in 2008. If I did that I would be forced to go out of state to see a doctor, and my insurance would likely try not to pay as the medical costs would be higher than my area.

I am still trying to decide if I should complain to the joint commisssion. They are the group that certifies hospitals as good and safe... they look at hospital admissions, infection rates, mortality rates, er data etc. They work with the federal and state governments. Bad ratings can cause hospitals to loose funding and research grants. Hospitals like where I went get most of their $ from the federal government. Of course they get lots of research grant money and state and county funding also.

The emergency medicine doctor said they were planning to do a CAT scan and give me torodol for pain. He also said the paramedic no longer works there. Neither my husband or I was told about these plans. I might have been able to hold on a little longer if I thought they were planning treatment. I have waited a long time before in radiology departments for X rays while passing stones, having a infection and having pain at maybe a level 5.... for the X Rays to be taken. My pain would have had to be addressed in 30 minutes.... it was horrible.

The emergency medicine doctor also asked me ? about pain medication use. He was trying to figure out if I had developed a tolerance to the morphine based drugs(the ones with most abuse and addiction potential). I had never had morphine before that I know of. I have always had demoral before in an IV, shots and pills... depending on pain level, sickness and or recovery level. I have had 2 open kidney stone surgeries. I have also had 2 ESWLs and 1 PCNL all before the 2007 3 utererscopies.
The doctor said my doses of morphine were both high doses... without medication my pain would have been higher than a 10....10+


I have never read about passing tissue and stents before. I belong to a kidney stone group on google. also Dr. Leslie helped write a kidney stone book:

[moderator note: website address has been removed]
[moderator note: e-mail address has been removed]

I did have a lot of nasty stuff in my foley catheter bag before my 2nd open surgery.... I had a bad infection for around 2 weeks. I was very sick and had septacemia for 2 or 3 days. Someone on the google group said about 30% of patients with that and kidney infections will die. It is when the infection is in your blood..blood poisoning so the infection travels around your whole body

mctripat

[Uro-Greif]

I would like to speak with you it a manner where i can learn more through your experiences if this gets through to you(perhaps by email) please My name is Bruce on here but [moderator note: email address has been removed.] i'm on the Barrier islands of the east coast maybe your close..im not going to call it tissue..more like my stent is causing me to sloth this ...well gotta go get a access tube placed in my back:) not sure why it is seperate procedures the one i watched was done with two teams in about two hours but this one is gonna stretch out for two days..any ideas why radiologist and urologist cant get a team that specializes in this?

[mctripat]

The access tube in your back is a nephrostomy tube... they are usually used if you have a bad infection from the stones and/or if the stones are over a certain size, I think it is around 5 cm
I have not been thinking about stones for a while, so I don't remember everything off the top of my head. The nephrostomy tube is like a Foley Cath only bigger but, it goes straight into your kidney not up through the bladder... It is used for a procedure called a PNL or PCNL, percantaneous nephrolithotomy. Sometimes the tube is in your flank (side)... it depends on where the offending kidney stones are located in your kidney.... I have had one in my side and one in my back.

If it is in your back and you have it in for a while after surgery, you will need someone to help you bathe around the tube.... your urologist will give you care instructions after surgery.


Some doctors put in right before your procedure and others will put in a day or two before surgery.... it can be a safety valve if your pain/infection gets worse before the procedure can be done. It is not always possible to predict what and when things will happen with stones, so the nephrostomy tube is important if your surgery gets moved up or is an emergency. I was told it is an interventional radiologist that puts the tube in... a radiologist or radio. resident is always in the OR for a PCNL or utererscopy... they do real time floroscopy to help your urologist see the offending stones.... although there are tiny cameras that go on nephroscopes and cystoscopes. The latter has channels on it so various attachments can be used or irrigation can be done.

They are probably not putting it in because the radiologist is busy or the room that will be used, when this is done is being used.... also it could be related to your infection/obstruction. Often they are put in at the beginning of surgery, after you are anethesized. Also radiologists are highly specialized and not all of them are trained in the kidney stone procedures....

A stent or nephrostomy tube can keep kidney stones from moving around, when you are sick as I mentioned above and used pre or post, and during surgery . Nephrostomy tubes are what the urologist uses to put his instruments up during surgery.... anyway when stones start moving around.... either due to a urologists surgical manipulation or on their own, they eventually most get stuck and create an obstruction or another obstruction (yes you can have more than one at the same time).... Also they can be very hard to see sometimes, no matter what instruments or radiological methods are used. They can shoot dye up through your bladder and track it as it filters through the kidneys/ureterers etc to help ... that test is called a retrograde IVP or interveneous pyelogram while you are anethesized to help find the obstruction. The dye makes the kidneys etc have more contast on the x ray films.

I did have emergency surgery a long time ago before...PCNL, utererscopy (URS) and ESWL were developed and at the end, I had a nephrostomy tube in my incision. I had one URS where they left the stent in after my first procedure until the 2nd one around 3 weeks later,.... I don't know if they had to remove it during surgery or not. But after my 2nd URS I had a new stent.

Not everyone has pain from the Stents, which are actually called Double J Stents. If you have spasms or bladder twinges.... Detrol LA will help with the discomfort. There are also internal stents and ones with a string... some can be left in up to 6 months and some up to 12 months. I doubt most are left in more than a few weeks, because the patient will either heal enough it can be removed or another procedure is scheduled withing a few weeks... unless the urologist is letting the infection get cleared up some before he does surgery, or he is busy doing surgery on other patients or waiting in line to use the OR. The OR rooms are set up especially for kidney procedures and some of the tools/equipment are not easy to move around.

When I talk about stones moving around... I get the impression they are in a small clusters together and if one stone moves, then the ones behind it can start to move around too... if that happens they you have colic and the horrible pain... Also they damage the kidneys/ureterers some when they move around... and I believe they just don't drop into your bladder but work their way through the kidneys/ ureterers. When I mentioned the clusters of stones and moving around: there is a German word for that and it means Street of Stones.... the ESWL machine was developed in Germany.

mctripat

[Uro-Greif]

the information you have shared with me with is correct, every thing you mentioned i have been through...ThankYou very much (mctripat) EVERYONE SHOULD READ YOUR POST!