Re: Ob: Suspected nephrolithiasis
From: Andrew Folley (agfolley@hotmail.com)
Wed Dec 27 16:21:32 2006
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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