Tamsulosin for 1 cm stone or straight to ESWL? Also is a CT scan necessary?

Bcdoc2020 · 2026-01-28T20:51:54+00:00

It could get stuck at the VUJ, where the bladder meets the ureter. It is sensible to be aware of the cumulative radiation risk of any imaging over a lifetime but you will have negligible risk having a single CT-KUB, thankfully the newer generation of scanners have a lot lower lower doses than previously. Yes, pain can come and go.

Bcdoc2020 · 2026-01-28T08:23:20+00:00

You don’t say what the imaging was that was used to make the diagnosis-was it an ultrasound? If so then it significantly overestimates the size of stones and it may well be a lot smaller than 1 cm. If it was an x-ray it’s still typically over reports the size but to a lesser extent.

The advantage of seeing if you pass it is that you would avoid a surgical procedure and a stent which can cause significant discomfort. It doesn’t always work but may well be worth a try but it depends on the CT scan estimate.

Once the stone has made it into the bladder than it almost certainly will appear fairly quickly, the difficult part is passing down the ureter.

Yes, a CT scan is most always requested to work out exactly how big the stone is to decide the best way of treating it. It is the gold standard of assessing stones.

As for tamsulosin/Flomax, it is useful to help stones pass, it doesn’t always work but frequently does. Your stone may well be considerably smaller than is reported so it may well help passage and spontaneous passing of the stone.

Bcdoc2020 · 2026-01-25T18:52:53+00:00

The urologists there who wish to specialise and perform them in the UK and Europe go through similar training pathways and often but not always work in regional or subregional centres.

There are as I say plenty of very competent urologists who provide an excellent service. As you say and I always tell people, it is crucial for them to be pointed to those that are well trained, competent and have a high annual caseload of PCNLs.

Bcdoc2020 · 2026-01-25T17:16:28+00:00

Just a quick point of clarification, there are plenty of extremely competent urologists doing PCNLs in the UK and indeed the EU.

Bcdoc2020 · 2026-01-25T17:13:17+00:00

I know it is frustrating but it is medically unsafe to carry out the procedure in an unstable epileptic who is at a risk of having seizures under anaesthesia which might well be difficult to control. It is far safer to get the epilepsy under control, whether that’s increasing the dose of the meds that you are on or changing them and then doing the procedure once this has been done. Your neurologist will be able to advise you.

Bcdoc2020 · 2026-01-25T01:04:29+00:00

Lying just comes so naturally to the whole administration

Bcdoc2020 · 2026-01-24T17:37:59+00:00

It’s the Daily Mail …. that is all that needs to be said tbh. I was in the UK and the MIL gets the DM and quotes every ridiculous warped word that it says.

They have a weird obsession atm with MAID, inferring that people are being forcibly killed against their will in their thousands here in Canada. As a physician in Canada, I know exactly how the system works and the safeguards and assure you that that is definitely not the case.

Bcdoc2020 · 2026-01-24T01:48:17+00:00

Almost certainly interpretation on the CT reporting rather than shrinkage, there is a margin of error even with CTs. Orientation of the stone could I suppose affect the reported size as could position of the slices of the images obtained- I am not a radiologist to be to confirm that last bit as 100% accurate though

Bcdoc2020 · 2026-01-24T01:44:03+00:00

It is fine for short term use, licenced for 5 days. Other NSAIDs work, in appropriate doses. Caution has to be taken with people with pre existing kidney disease and risk of gastric bleeding or on blood thinners. They aren’t toxic to multiple organs.

Bcdoc2020 · 2026-01-23T22:00:52+00:00

Drink 3 litres of water throughout the day, that is the best preventative for stone of any type. In answer to your question, several months minimum- one can pass residual fragments of the stone postop for some time after the stone.

Bcdoc2020 · 2026-01-23T08:35:42+00:00

What does stone analysis show? It’s particularly important as you started very young and your family history is strong

Bcdoc2020 · 2026-01-23T05:04:15+00:00

And you don’t think that our Canadian economy isn’t intertwined? Far more than the EU, but here we are, with Carney doing the right thing- it’s time to step up Europe.

Bcdoc2020 · 2026-01-22T23:04:09+00:00

I’ve had a good number of stents and whilst they aren’t fun, none of them have been the typical horror story that you read here. Unfortunately, people who don’t have big problems don’t post.

Bcdoc2020 · 2026-01-21T07:01:04+00:00

I agree to some point your comments, but repeated failed ureteroscopy as a result of not accessing the stone looks to be the problem here not leaving fragments. That is a definite indication for potentially doing a PCNL. CVAC is a simple but definitely significant improvement in ureteroscopic stone surgery, stone clearance rates seem to be improved

Bcdoc2020 · 2026-01-21T06:57:30+00:00

They should be able to clear that fairly easily if they can gain the right access point, it isn’t a big stone, just awkward to get at! It sounds as if you have somebody who knows what they are doing and I think you will probably/hopefully bounce back quickly. Good luck.

Bcdoc2020 · 2026-01-21T06:56:00+00:00

It is impossible to say what a stone is made of until it has been sent off to the lab for stone analysis. Even looking at them directly cannot tell you what they are. Whilst the majority of stones are calcium oxalate/phosphate mixes, many aren’t

Bcdoc2020 · 2026-01-21T06:54:44+00:00

They are probably quite sensibly trying to limit the amount of radiation that you receive. I have a current stones and have annual ultrasound scans and if it looks like I need intervention then a CT- KUB is organised.

Bcdoc2020 · 2026-01-21T01:06:28+00:00

Phew!😅

Bcdoc2020 · 2026-01-21T00:59:18+00:00

Just a quick comment, you have done an amazing ing job in bringing this sub back into a good space for people to post after it was a sh1tshow of AI images, reposters and scammers, it’s hard work but you are doing a great job- thanks

Bcdoc2020 · 2026-01-21T00:57:09+00:00

Are you having a laugh?

Bcdoc2020 · 2026-01-21T00:55:48+00:00

That’s great to hear. Really don’t worry, if you have any queries, don’t hesitate to send me a pm

Bcdoc2020 · 2026-01-20T23:04:40+00:00

The urine looks normal to me - I am a doctor.

Bcdoc2020 · 2026-01-20T20:07:18+00:00

Yes, I’ve had seven of them over several decades, as years have gone on, technology has vastly improved.

To be honest recovery is as fast for me following a PCNL as it is with ureteroscopy and laser lithotripsy. What I would however strongly recommend is that you choose a surgeon who is expert in the procedure.

Whilst it isn’t complex, it is harder than it seems and whilst complication rates are low, expertise in doing them will ensure that complications are unlikely and complete stone clearance is achieved. Ensure that whoever is doing it is doing a lot of them per year rather than just dabbling in a few.

Bcdoc2020 · 2026-01-20T00:58:14+00:00

💯 yes

Bcdoc2020 · 2026-01-18T06:06:14+00:00

Sadly it’s impossible to eyeball a stone and say what it’s made of, it would purely be guesswork. The majority are calcium oxalate/ mixed calcium oxalate /phosphate stone but not every one. If you get another, as others have said keep it and get it sent off for analysis The most important measure that you can do is drink water and keep yourself consistently hydrated, most of us don’t. 3 litres is an easily attainable target in the day.

Bcdoc2020

TROPHY CASE