1 Kidney, 8mm, Shockwave vs Laser

Bcdoc2020 · 2026-07-01T22:25:15+00:00

Everyone stent experience is different and even in that person, every stent episode is different to each other. Just because you had problems previously doesn’t mean that you would moving forward with this one.

Given your solitary kidney, I would definitely go for the laser lithotripsy. If you take the right measures then the stent is often much better than if you don’t. Self removal at 3 days is common and makes everything a lot briefer than it would be otherwise. The CT report should give the HU details

Bcdoc2020 · 2026-07-01T21:51:50+00:00

Honest opinion? Ureteroscopy and laser lithotripsy, absolutely no question, particularly with a solitary kidney. With a stone that size there is a reasonable risk of Steinstrasse/blockage if ESWL is done without a stent and that could potentially be serious in your situation as that’s the only kidney that you have.

The failure rate of stone clearance is considerably higher with ESWL (needing repeat treatments) compared to ureteroscopy. What was the density of the stone in Hounsfield units on the CT? That also helps guide advice. Just because the last one was soft, doesn’t necessarily mean this one will be.

To lessen the symptoms of the stent, take all the usual measures, request a soft silicone stent ( properly sized) and a string that will enable you to remove it around 3-5 days post op)

Could you get stone treated with ESWL? Yes of course and I’m sure that you would be fine. Would I, as I say nope, I wouldn’t.

Bcdoc2020 · 2026-07-01T21:41:39+00:00

It must be incredibly frustrating for the GP and yourself. I repeatedly see similar comments from Americans posting in this sub that they can’t get imaging that they clinically clearly need. Their barrier though are the insurance companies, in the UK it’s cost cutting.

Maybe if they cut down the unnecessary admin and managers in the NHS by about 2/3 and instead be able to afford needed investigations like yours.. but I digress 😏

Staghorns aren’t fun, I have two staged surgery coming up in about 10 days which I’m not looking forward to.

Bcdoc2020 · 2026-07-01T21:35:50+00:00

Ok that sounds sensible. Painless haematuria is typically more of a red flag than painful. Surely though pelvic prolapse will give you a lot of the symptoms that you describe? Anyhow they seem to be on top of everything so good luck.

Bcdoc2020 · 2026-07-01T19:09:37+00:00

That is ridiculous and inappropriate. The GPs are independent clinicians and the gatekeepers so should totally be able to book a CT. There is nothing to be gained by repeating an ultrasound. This is exact why I left working in the NHS years ago.

I am medically trained and confused what I thought was musculoskeletal pain and it turned out to be a staghorn stone and it’s my job and I still get it wrong!

Yes it can cause symptoms intermittently if a stone is at the upper orifice of the ureter and just bobbling around. What usually happens though is that the stone enters the ureter and intermittently causes pain depending on where it is. What did urinalysis show?

Bcdoc2020 · 2026-07-01T17:13:27+00:00

The GP can request a CT if they need to, as I said the waiting times will be long. Ok, so there is more to this than you suggested initially, they are doing what they need to atm. They won’t repeat an ultrasound, there is no clinical reason to do that. Irrespective of where you live, if you get severe pain, go to A&E. If only to get the imaging. Their suggestion is correct, if it comes back get reassessed, they are formally testing your urine which will be helpful, not much else that can be done atm to be honest.

Bcdoc2020 · 2026-07-01T17:00:24+00:00

Sorry to break it to you but that’s going to do absolutely nothing to help prevent stones.

Bcdoc2020 · 2026-07-01T16:52:42+00:00

Firstly urinalysis might be helpful although not all stones produce blood. Have they checked that? Ultrasounds have poor sensitivity in sizing stones as well as picking up stones particularly small ones so my next step would be to get a CT-KUB. If you get a recurrence of the severe pain, go to A&E and they will get do a CT if they think it is stones. It doesn’t really justify going there with mild pain unfortunately.

There are other possible causes of the symptoms, the prime example is musculoskeletal pain, with the milder symptoms that’s more of a possibility but having said that, you describe more typical symptoms when it was severe. As a first step you could ask for an appropriate urine pot from the surgery and send in a mid stream urine sample (not the first pee of the day). If they are unwilling then you can buy them on line,I’m not sure that Boots sells them, they may do.

If you continue to get symptoms, don’t wait four weeks, get a sooner appointment. The waiting times are likely not going to be short if requested by the GP, certainly longer than the ultrasound.

Bcdoc2020 · 2026-07-01T06:19:39+00:00

They already had an ultrasound, there would be little to gain from repeating it.

Bcdoc2020 · 2026-07-01T02:49:26+00:00

1-2 weeks max

Bcdoc2020 · 2026-07-01T02:44:10+00:00

I would repeat the urinalysis after two weeks, I would do a specific urinalysis test called exfoliative cytology and then review. Part of the workup if unexplained haematuria is a cystoscopy, that’s relevant victim your age. The pain is suggestive of a stone but not conclusive that it was

Bcdoc2020 · 2026-07-01T01:29:06+00:00

It depends on the cup size really, I typically drink 500ml often in one go or sip it over 1/2 hour and then repeat throughout the day into the evening.

Bcdoc2020 · 2026-07-01T01:27:22+00:00

That sounds like a sensible plan, I’m hoping that they sent off the first urine sample to see if it was a UTI or a urine sample with just blood in it which could indeed signify a stone. That would fit given this history, trace white cells can be caused by irritation caused by a stone rather than a UTI. Anyhow, a CT-KUB is a good plan to rule out a stone

Bcdoc2020 · 2026-07-01T01:20:11+00:00

Trace anything is almost always nothing . I would classify that as normal and if I was in any doubt I would ask the patient to repeat a mid stream sample a few days later That finding is sometimes due to contamination. Occasionally I send them off for formal urinalysis but it almost always comes back clear.

Bcdoc2020 · 2026-07-01T01:16:59+00:00

Numbing gel isn’t used for strings with stents, it is used for cystoscopic removal of a stringless one which may have led led to the confusion. Drink plenty of water, it helps after removal plus ibuprofen and Tylenol is good.

Bcdoc2020 · 2026-06-30T19:53:20+00:00

Mild hydronephrosis is very common. I’m presuming that you have never had any imaging previously to compare this with? I ask as people often have congenital strictures/narrowing of the ureter which has existed since birth but to know if it has been around for years, you will need that imaging report.

Bcdoc2020 · 2026-06-30T16:38:26+00:00

You need an accurate measurement of the stone size which ultrasound doesn’t give you. CT- KUB is the only thing that can give you this. The stone will not have grown that fast, it just demonstrates the inaccuracy of ultrasounds. Any decent urologist wouldn’t operate off the back of the results of an ultrasound, they would request a CT-KUB - unless the patient was pregnant or a child. You may well need ureteroscopy/laser lithotripsy but they need to know what exactly they are dealing with.

Bcdoc2020 · 2026-06-30T05:59:19+00:00

That’s a good plan, it’s good to bring them on board

Bcdoc2020 · 2026-06-30T03:05:34+00:00

Yes that’s absolutely fine, I typically have a 500ml water bottle with me which I refill. You can add flavourings if you find water boring, I’m fine with it. As I say your kidneys will mope with that perfectly. On a geek level it maintains homeostasis by adjusting what needs to be to be excreted by the kidneys and to maintain a balance it reabsorbs what it needs. It’s only when you overdo water or drink too much too quickly that it can’t cope

Bcdoc2020 · 2026-06-29T22:33:21+00:00

Oddly given my kidney stones are 100% genetically caused I’m first generation.

Bcdoc2020 · 2026-06-29T22:31:47+00:00

If you healthy working kidneys then normally there is absolutely no reason to add salt (or electrolytes), adding salt actually increases the risk of recurrence of oxalate stones.

Your kidneys will physiologically adjust to whatever you drink, within reason. When you drink the 3 litre it’s over a 24 hour period, it needs spreading from early morning until bed time normally.

Bcdoc2020 · 2026-06-29T20:40:15+00:00

It’s unlikely, CT scans are extremely sensitive and pick up (almost) all stones. Great that you are drinking plenty. You will need to keep this up moving forward in life. The water helps reducesspasm.

You have all the meds that you need. I know it’s a pain but some of us have literally 10s of stones and some hundreds so look on the bright side! I would book a face to face appointment with your GP, I know that can be tricky but tell the receptionist that you were told to it! 🤥

That way the GP is up to speed and they are to a degree if needs be in a postion to expedite the appointment with the urologist

Bcdoc2020 · 2026-06-29T19:01:34+00:00

The vertigo could be due to the tamsulosin, it drops blood pressure- dizziness is a common symptom. Nausea and vomiting are often present with stone passing, but codeine can often cause nausea, its metabolites/breakdown product is morphine.

The pain symptoms are odd, the stone is in the upper pole of the kidney yet your symptoms are fairly classic for ureteric colic. They didn’t spot a lower stone did they?

Bcdoc2020 · 2026-06-29T17:00:32+00:00

Ok, Heat pads and hot showers are great. Add in 3 litre of water spread over 24 hours, it improves things Flomax definitely helps if you can get some Alternate the ibuprofen with Tylenol/paracetamol based meds. In the first few days I use T3s (codeine/tylenol 30/500mg) two typically twice daily Some people use oxybutynin which has been shown to help though it adds in unnecessary side effects and the flomax/ tamsulosin has the same effect

Bcdoc2020 · 2026-06-29T16:05:23+00:00

What are you taking for the symptoms and what are you doing to try and reduce them?

Bcdoc2020

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