Re: Ob: Suspected nephrolithiasis
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Wed Dec 27 17:38:28 2006
Both the urologist and I are familiar with that.
Thanks,
Garry
At Wed, 27 Dec 2006, Andrew Folley wrote:
>
>Garry
>If pain increases to point that something needs to be done, ask the
>urologist to consider placing a "double J" ureteral stent from bladder to
>reanl pelvis. andy
>
>>From: Ronald Ainsworth <ainsron@sbcglobal.net>
>>Reply-To: ob-gyn-l@obgyn.net
>>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>Subject: Re: Ob: Suspected nephrolithiasis
>>Date: Tue, 26 Dec 2006 13:21:47 -0600
>>
>>Follow and treat symptomatically. You've done what you need to do to rule
>>out serious problems - infection, hydronephrosis, etc. What benefit would
>>it have to do any other testing, such as an IVP or cystoscopy? Is there
>>any evidence you would gain that you would use for therapeutic decisions?
>>I don't think so.
>>
>>"Garry E. Siegel, M.D." <garrys@mindspring.com> 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
>>
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--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
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