The patient is a young foreigner who just finished his four year college course in a local university. He was scheduled to return home for a visit but because of the on and off pain he was suffering despite the medications he was taking, he was forced to seek consultation with an MD Surgeon referred by a close friend.
He described his pain to be more at the left side of his back and tolerable except on one occasion several months ago when it was so severe lasting for around 2 to 3 hours. He said he was diagnosed to have at least “3 small stones” at his left kidney in the Medical Center he was rushed to and was just prescribed some medications. At present a slight on and off pain is experienced at his left inguinal area.
The consulted MD Surgeon requested a plain ultrasound of his kidneys, ureter and urinary bladder or KUB which revealed a stone at the junction of the left ureter and the urinary bladder. There is also an enlargement of the left kidney described as “mild hydronephrosis”.
In layman’s terms, “hydro” may refer to water, “nephro” to kidney and “sis” to inflammation so that the word, “hydronephrosis” may mean “inflammation or enlargement of the kidney due to accumulation of water or urine.” In this patient it is due to the obstruction of the passage of urine by a stone. Obviously if the obstruction were not removed, the kidney would eventually be destroyed.
Enlargement in general is not immediate. It would take some time so that in this patient the obstruction has been there for quite some time. Probably it occurred when the patient felt severe pain because in general severe pain occurs when the stone moves or is carried along the urine pathway. It also stops when the stone also stops moving. It may also be passed out with the urine if it is small around .4 cm or less in diameter. Pain due to the enlargement on the other hand, may be described as “dull” and very tolerable.
The obstruction may not decrease the amount of urine because of the urine coming from the other normal kidney.
Kidney stones maybe left alone provided they do not obstruct the excretion of urine. Urologists who are specialist in this surgical field study individual cases meticulously and advise removal of the stones not only because of actual or potential obstruction but for other indications. Being foreign bodies, they may be the cause of non-responsive or chronic urinary tract infection. Patients with stone may have repulsive smelling urine despite the increased intake of fluids. Lately after several studies, they may be the cause of malignancy especially in the urinary bladder.
Previously, the only option to remove the stone is surgery. Nowadays, a Lithotripter machine which creates “shock waves” is employed by highly trained Urologists to break the stones into small particles which may then be easily excreted with the urine. With the use of ultrasound or x-rays to pinpoint exactly the location of the stones, the adjoining tissues are left undamaged making the procedure highly safe. Bigger stones may require several sessions or outright surgery depending on the expert assessment of the attending Urologist. This procedure of course is done under sedation or general anesthesia.
Although the foreigner patient agreed that the stone cannot be dissolved with medications, he disagreed that no medicines is available to remove the obstruction. He even argued that it is available in the country he came from. The attending MD Surgeon realizing perhaps his lack of knowledge advised him then to consult a Urologist because they are the experts on this field or perhaps he could leave earlier so he could consult the more knowledgeable MDs in his faraway country.**
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