-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: Ob: Suspected nephrolithiasis From: D. Ashley Hill (dahmd@cfl.rr.com) Tue Dec 26 20:11:58 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dean Huffman .: "Former President, Gerald Ford, Dies At 93" Previous message: DoctorJoe@aol.com: "Re: Some doctors get break on insurance" In reply to: Garry E. Siegel, M.D.: "Ob: Suspected nephrolithiasis" Next in thread: Garry E. Siegel, M.D.: "Re: Ob: Suspected nephrolithiasis" Reply: Garry E. Siegel, M.D.: "Re: Ob: Suspected nephrolithiasis" Garry- If I'm reading this right, it sounds like a patient at 7 weeks with unilateral flank pain but no diagnosis yet with a normal urinalysis and renal sonography. I agree with others that radiography is not indicated (since the renal sono showed no hydronephrosis). I'm not sure that an IVP would even show a stone, since the UA revealed no hematuria. If it's not a stone it could be something very unusual like ovarian vein syndrome, where the gonadal veins compress the ureter, but I suspect that would cause some hydronephrosis. We see a lot of stone patients for some reason. I recall that about 85% of stones <5mm pass on their own within 3 weeks of presentation. If you want to try things to speed the process, one trick the urologists taught us is the "stone cocktail" of procardia (to dilate the ureter), oral prednisone (to decrease ureteral inflammation and pain) and narcotics or NSAIDs as needed. We've used these later in pregnancy with good results. I'm not sure if there are RCTs to support this. Good luck. Happy Holidays and I hope you have a great 2007. Ashley At Mon, 25 Dec 2006, Garry E. Siegel, M.D. wrote: > >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 > -- D. Ashley Hill, MD Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Medical Director, Loch Haven Ob/Gyn Group Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando Orlando, Florida Next message: Dean Huffman .: "Former President, Gerald Ford, Dies At 93" Previous message: DoctorJoe@aol.com: "Re: Some doctors get break on insurance" In reply to: Garry E. Siegel, M.D.: "Ob: Suspected nephrolithiasis" Next in thread: Garry E. Siegel, M.D.: "Re: Ob: Suspected nephrolithiasis" Reply: Garry E. Siegel, M.D.: "Re: Ob: Suspected nephrolithiasis"

Return to

Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Thu Oct 2 04:55:00 2008

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.