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Forum Name: Surgery Topics

Question: Surgery Options....please help!


 JDubC3 - Thu Jan 11, 2007 8:49 pm

I'm a 24 y.o. male who just had surgery for a 1.4 cm kidney stone, on the right side of my body (my right). My doctor told me that it was the biggest kidney stone he has ever seen, and the fact that it is stuck in the (I think ureter tube) was beyond him. The surgery was for a stent, and it has been in place for about a week. I went to the urologist today, and he gave me two different options for surgery. One is an outpatient procedure where they go in through my urethra with a laser and blow up the kidney stone into pieces. He told me that the downside to this surgery is that because it is such a huge stone, it might leave scarring due to the trauma. He also told me there is a chance that a piece of the kidney stone might fall back into my kidney, where they won't be able to find it. The other option he gave me was that he would make 3 small incisions (one by my belly button, one to the right of my belly button, and one towards my upper ribcage). They would cut open the tube and remove the whole kidney stone, then sew the incisions up. This would guarantee the complete removal of the stone. I would have to stay overnight, and both procedures would take about 3 hours. I asked him which one he would do, and he said the first one where they use the laser. I'm a little confused to why he would pick that one when in fact there is a chance that I would have to come back for another surgery. I am scheduled to leave for the Army special forces in May, and am currently enrolled in college for my last semester. I have NO CLUE as to which one I should do, and which one would be the best for me. Is there ANYONE out there that could give me some advice A.S.A.P. PLEASE HELP! Is sexual activity ok right now, or should I wait until my stent is removed?
Also, a while ago (2004) I had surgery for hernia, and was also told that I have too many veins in my left testicle that could be decreasing my sperm production. I was supposed to contact a urologist and get my sperm checked, but I never did. He said that it didn't need to be done right now, but if I wanted to have kids later on in life, that I should get it done. I was wondering if I should bring this up when I call back my doctor to schedule the surgery, or if I should wait until I got into the military and get it done then? How long would that surgery set me back? Can you bounce back quickly from that kind of surgery?
 Theresa Jones, RN - Tue Jan 16, 2007 8:49 am

User avatar Hi JDubC3,
The most probable reason the physician chose the laser procedure is even though there are risks regarding scarring and loss of a piece of the stone, this is the least invasive procedure. There are risks associated with any surgical procedure. A 1.4 cm stone is a considerable size and you have to choose the procedure that you feel most comfortable. When you call to schedule ask for information pamphlets regarding both procedures. Below this post you will also find two links provided by Cornell University Department of Urology regarding various procedures including the two that you mentioned. Hopefully it will assist you in your decision making process. Have you went back to the physician for a follow-up appointment regarding your stent placement? Generally speaking, sexual activity is usually delayed until your return appointment. You should have also received a discharge paper after the procedure regarding activity etc. Inquire about resuming sexual activity and regarding sperm count when you call your physician. I hope find this useful.
Click here!
Click here!
Best wishes.
Sincerely,
Theresa Jones, RN
 JDubC3 - Tue Jan 16, 2007 11:11 am

Theresa Jones,

Thank you very much for your response, and yes those links helped out a lot. To answer your question, I did go back to the doctor to talk about limitations and sexual activity. I was told that I had no limitations, and to return to activity, or sexual activity whenever I felt I was capable. I go back into surgery on the 29th, and decided to do the laser procedure. It seems like the best possible surgery for me, especially if everyone seems to agree. Once again, thank you so much for your response.

Jay
 Dr. Tino Anthony Solomon - Tue Jan 16, 2007 1:51 pm

Hi JDubC3,

As you have probably been well informed by the Cornell website, treatment of kidney stones can be approached from three angles, conservative, surgical and minimally invasive surgical. The laser option that your urologist has offered you is, although technically a ‘surgical’ procedure, probably your best option as the first line treatment because it is less invasive than other methods. Conservative therapy is not really an option here due to the size of the stone. I will assume that you would have read the website information thoroughly and therefore will not need more explaining about the procedure for the time being.

However I would like to find out more from you about the veins that you claim are affecting your sperm count. Do you know what term your doctor gave them? It sounds from your description that you have a varicocoele, which is a mass of enlarged veins in the spermatic cord. They are found in 1/10 people and most commonly in those of your age group. The reason they form is because the venous drainage of your left spermatic cord, which is attached to your left testicle, can be compressed further up in the body by larger arteries and veins. This can impede the blood flow from the left testicle and thus cause an engorgement of blood. As the blood is not flowing as it should do, it does not cool and can raise the temperature of the testicle and theoretically cause infertility. This can happen to the right testicle as well although it is less common as the route it takes avoids compression by other arteries and veins. If this is the case you will need to be consulted about its management by your urologist, but after the main problem of your kidney stones have been resolved. Please keep me informed.

Kind regards,

Dr Tino Solomon
BSc(Hons) MBBS
Senior House Officer in Surgery
 JDubC3 - Tue Jan 16, 2007 8:09 pm

Dr. Tino Anthony Solomon,

Yes! That's exactly what he called it (varicocoele). I already had surgery for hernia, and at that time they also took the lining out of my right testicle. They said they were going to do both (hernia, and the varicocoele) at the same time, but when I was in recovery they told me they decided not to do it, and I could pursue it later. They told me that I should go get it checked out later on if I wanted to have kids eventually. I never did, thus why asking if I should do it. Will also keep everyone informed about how the kidney stone goes. To be quite honest I'm a little annoyed with the whole process. My surgery isn't until the 29th, and the doctor won't call in anymore pain medication, and Advil doesn't work. I try to drink as much water and liquids as possible, but find sometimes that I am almost urinating pure blood? Is this a problem? Should I be worried?

Thanks,
Jay
 Dr. Tino Anthony Solomon - Wed Jan 17, 2007 12:09 pm

Dear JDubC3,

What you describe is haematuria, or blood in the urine. This is a direct result of the stone irritating the lining of the urinary tract and causing bleeding which is passed out with urine, discolouring it. At first it may appear to be a lot of blood, but in fact it usually is the result of a few millilitres of blood causing discolouration of a larger volume of dilute urine. You are doing the right thing in keeping well hydrated as this can prevent further stone formation in some types. I wouldn’t worry about the blood unless it is accompanied with severe flank pain, fever, malaise and/or a general feeling of unwellness, as this could indicate an infection has set it and will need to be treated to prevent damage to the kidneys.

Regarding your varicocoele; a simple way to determine its effect on your fertility is to analyse a sperm sample. The sperm number and quality can be determined by examination under a microscope and your specialist can use this information to come to a decision with you about surgical intervention sooner rather than later.


Kind Regards,

Dr Tino Solomon
BSc(Hons) MBBS
Senior House Officer in Surgery
 JDubC3 - Wed Jan 17, 2007 3:43 pm

Dr Tino Solomon,

Your responses were a lot of help. I was going insane wondering what was going on, considering my doctor doesn't like returning phone calls. I think creating this site was one of the smartest things anyone has ever thought of. Will keep everyone informed as to what the results show.

Thanks again for your time and knowledge,
Jay
 Dr. Tino Anthony Solomon - Sun Jan 21, 2007 5:53 pm

A pleasure
 JDubC3 - Tue Jan 30, 2007 10:48 pm

Just wanted to let everyone know that the surgery went well. I didn't get a chance to talk to the doctor, but he did talk to my parents after the surgery. He told them that he is pretty sure that he got the whole stone out, but there was some trauma to my ureter tube so they had to keep the stint in for about a week. I have an appointment on Thursday, February 8th to get x-rays done. They will then let me know if they can remove the stint or not. Does anyone know if I am going to be awake for that process? The removal of it that is. I am thinking that it would be extremely painful considering what it feels like to urinate right now.
 Dr. Tino Anthony Solomon - Sat Mar 03, 2007 1:24 pm

It can be removed under a local anaesthetic or general anaesthetic. This will depend on the type of the stent placed and its duration. You would be best advised asking your surgeon what he plans to do or consulting the information leaflets given to you at the time of placement.




Kind regards,

Dr Tino Solomon
BSc(Hons) MBBS
Senior House Officer / Foundation Year 2 in Surgery

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