Ureteric stone plus vesical calculus

Kindly give your opinion on this case especially that 18mm vesical calculus?? Chief Complaints A 45 year old male patient reported to the OPD with complaints of pain in suprapubic area accompanied with dysuria and increased frequency of urination for last 2 days. No complaints of hematuria or so. Investigations Upon urine R,M,CS and USG KUB it shows, RBC - 10 to 12 WBC - 3 to 4 Trace proteins + Calcium Oxalate No organisms growth on culture reported USG revealed distal ureteric calculus in left ureter along with a vesical calculus. I vaguely remember ureteric stone was about 4mm and vesical calculus was around 18mm. Management He was started initially on levofloxacin 750mg OD along with other drugs on which he significantly imroved, and upon getting the reports I added him Tamsulosin 0.4mg H/S along with a alkaliser syrup and advised plenty of fluids.

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Ureteric stone 4 mm , there is every chance of automatic passage of the stone without any active treatment only iral hydration is enough Vescial stone 18 mm is a matter of concern because it may lead to recuurent urinary tract to stagnation of the urine particularly in this where is enlarged prostate causing chronic obstruction of passage of urine leading to more chance of infection leading to more stone formation. Management Plenty of water and to treat UTI after doing C/S test with proper antibiotic Stone may be removed by cystosopic cystolitotomy Sometimes stone may be crushed by laser therapy and then by flushing the bladder to remove the stone Sometimes it may not be possible to crush the stone due to hard consistency may be removed by cystolithotomy.

Thanks Dr Bipin Bihari Jain
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Any vesical stone is either a ureteric/renal calculus that has come down in which case it is generally less than 10 mm or a denovo stone developed in bladder. In either case the stone should ce put spontaneously when it is less than 9 mm. If there is a stone in bladder that has not come down one has to assume a distal obstruction. Either a Prostate, BNO or urethral stricture. The irritative symptoms.are due to the presence of the stone on the trigone. So any medical therapy for reducing the symptoms is usually unsuccessful. You need an U/s kub full bladder and postvoid and an Ascending urethrogram to settle the cause of the retention of the stone in bladder. Once the cause is identified treat the cause and also the effect - calculus.

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Mind opner question Bladder stones are mostly due to residual urine Ideal to start tamsulosin point4 Alkalaniser potassium citrate 60 meq/ day Sy protrate mb6 10 ml tds Lasilactone1/2 od Cystone tab tds Or berberisvulgaris30 tds Plenty of water more then 2 litre to consume avoid milk & milk products

Continue tamsulin and citralka Follow up ultrasound for distal ureteric stone Vesicle stone will harm none to patient . Issue is clearence of ureteric stone .. No need to intervene with vesicle stone

Vesical calculus of large size hard to come out conservatively Better subject cystoscopy with vesical lithotomy So far 4mm ureteric calculus will pass with treatment given add diuretics

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URETERIC CALCULUS..4MM.. NEED'S.. HYDROTHERAPY.. BUT.. VESICULAR CALCULUS..18MM.. NEED'S.. SURGICAL INTERVENTION..WITH. UROLOGISTS OPINION..

Tnx Dr Vipin Bihari Jain
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A larger calculus of 18 mm .. (considering 8mm UVJ) .. must be treated by doing cystoscopic evaluation and treatment as needed..

Thank you Dr. Ajeet..
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Apparently ureteric calculus needs force diuresis, Vesicular calculus requires surgical removal

Thanks Dr. Kute Ankush
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Go for lithotripsy with cystoscopy And treat accordingly

Stone should pass spontaneously for ce put

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