Non-obstructing Stones

Hello everyone, my name is David Tzou,

I’m a urologist here at the University of Arizona.

And today’s question is

why do doctors tell kidney stone patients

that their stone is

not causing them pain when it’s just hanging out in the

kidney and not obstructing their ureter, that tube

that connects the kidney to the bladder?

I think we’re all in agreement that when the stone generally

causes obstruction

and there’s like swelling of the whole fluid part

of the kidney, that patients can experience some

of the worst pain of their life.

But when the stone is just hanging up inside the kidney

and the CT scan

or some sort of imaging shows

that it’s not causing a whole bunch of swelling, uh,

I think traditionally that has been said that

that doesn’t cause pain and urologists even have said, oh,

that’s gotta be in your head.

I personally don’t agree with that.

I’ve seen enough patients to know

that there are can be stones that are not causing blockage

that do cause a lot of pain.

And when you can get in there, we can actually see some

of those stones have very kind of spiky appearance

to their exterior and that can really make it so

that you think that about that rolling around

inside the kidney and the kidney inside is very inflamed

and it seemed like it would be very painful.

So I do agree that there are patients who

removing those stones can be in their best interest

and can cause that pain to go away.

We’ve certainly seen that and agree with that

counseling is important right, to share

with the patients that while the stone surgery,

can remove it.

It does come at a cost of having the surgery,

having the scope go in there, but it can pay off

and remove that pain so that they don’t have

to continue to experience it.

And we know that when we go in

and actually remove these stones,

these patients feel better.

So, I can’t imagine

that being just all from it being in their head.

in general, I now am willing

to operate on those patients even though they might have

smaller stones with the full kind of counseling beforehand,

that yes, while our experience has shown that a lot

of patients improve in their symptoms

and have relief of their pain afterwards,

that it’s not a guarantee, right?

So that counseling beforehand has set expectations to know

that, well, yes, this is a very likely outcome,

that their pain goes away, I can’t guarantee it beforehand.

And if they expect that afterwards no matter what,

then we’re a little bit on different expectations.

So I think as long as that counseling is in place,

I think patients can really benefit sometimes from having

these non obstructing stones removed.