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Re: Ob: Suspected nephrolithiasis From: zygote@icsi.net Mon Dec 25 19:57:26 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joe: "Re: Ob: Suspected nephrolithiasis" Previous message: Joanne Bulley, MD: "Re: Gyn: HPV high risk positive and vaccination" In reply to: Garry E. Siegel, M.D.: "Ob: Suspected nephrolithiasis" Next in thread: Joe: "Re: Ob: Suspected nephrolithiasis" Having seen several patients like you described, your gut is most correct. Treat symptomatically, and image as required. Unlikely loss would be caused by cystoscopy or extraction. Since renal scan negative currently temporarizing is most appropriate Bob On 25 Dec 2006 at 20:42, Garry E. Siegel, M.D. wrote: Date sent: Mon, 25 Dec 2006 20:42:16 -0600 Send reply to: ob-gyn-l@obgyn.net From: garrys@mindspring.com (Garry E. Siegel, M.D.) To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> Subject: Ob: Suspected nephrolithiasis > 31 YO P0000 at 8 weeks. She is a CNM. > > She has a history of hematuria (dipstick and micro, not gross) predating > pregnancy, and saw a urologist who suspected a small, asymptomatic > stone, but no imaging done. > > Now, she is having daily unilateral flank pain radiating to her groin, > and was in enough pain/nausea last night to be admitted for IVF. She is > fearful of any meds for pain, and didn't require an anti-emetic. Her > hope is that IVF over time will help with passage of the suspected > stone. > > Her exam is benign, CBC and metabolic panels normal, and normal u/a with > a culture pending. > > Today's renal ultrasound is totally negative, and she has a viable 7w5d > gestation. The radiologist says that any stone big enough to warrant > consideration for extraction would result in hydronephrosis, and there > is none. > > In speaking with the urologist, we kicked around a limited IVP (scout, > and one or two post injection shots) versus simply using pain > meds/anti-emetics; the patient is torn and really wants to do nothing. I > have advised taking meds as needed and delaying imaging until later (12 > weeks, and only if symptomatic) for her peace of mind. > > I'm really not too worried about a limited IVP here--and I believe > Ashley had a nice paper from around 1995 regarding radiation in > pregnancy. Both the urologist and radiologist are hesitant, and the > urologist was worried about a cystoscopy (if needed for extraction) > causing an abortion. > > I've really not ever seen problems with indicated imaging studies such > as a limited IVP, or cystoscopy--realizing that the numbers of bad > outcomes would be exceedingly small, and the number of cases I've seen > isn't huge. > > My gut says take meds prn and image at some point--as per above. > > Any thoughs? > > Garry > > -- > Garry E. Siegel, M.D. > Private Practice > Roswell, GA > Robert J. Carpenter, Jr. MD 6624 Fannin, #2720 Houston, TX 77030 (O) 713-795-4600 (F) 713-795-4422 "Life is difficult" The Road Less Travelled by Scott Peck Next message: Joe: "Re: Ob: Suspected nephrolithiasis" Previous message: Joanne Bulley, MD: "Re: Gyn: HPV high risk positive and vaccination" In reply to: Garry E. Siegel, M.D.: "Ob: Suspected nephrolithiasis" Next in thread: Joe: "Re: Ob: Suspected nephrolithiasis"

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