The lithotripsy didn’t work.


This means that I have to have another stone removal procedure tomorrow afternoon.

Tomorrow’s procedure is called a ureteroscopy (URS), vs. the extracorporeal shockwave lithotripsy (ESWL) I had done last week.

Doing some research online (PubMed, MedLine, etc.), indicates that in studies ESWL is effective about 84% of the time depending on the size and/or composition of the stone, whereas URS is 98% effective.

For smaller stones (< 6mm), ESWL is about equally effective as URS on all but cystine stones, which are extremely hard and resistant to ESWL. From my doctor's read of the initial CT scan taken, he thought that it was not one large stone (like the ER doc thought), but a smaller stone, and a phlebocyte (or something like that), since on some of the slides, there are 2 small dots, instead of 1 big one. After the procedure is when he figured out that it is indeed a larger stone; hence why he had me come in for my follow-up in one week, instead of two. Yesterday's X-rays show 1 large stone, and 2 phlebocytes. ESWL is currently the most common treatment (other than "observation") for kidney stones. URS is more invasive than the lithotripsy; and requires full anesthesia (hence, more "risky"), vs. mild sedation for ESWL. They'll be using a laser to break-up the stone before extracting the larger pieces with a wire basket. One of the major risks is that the stone gets pushed further back up the ureter, or possibly into the kidney ("retrograde stone migration"), requiring an actual surgical intervention to remove the stones; another is damage to the ureter itself from the wire baskets or other instruments being inserted. So what does this mean to me? It means another two days off work, another day of fasting and not drinking, and very likely a sore dick. Joy!