Ureteral Stones: Symptoms, Treatment, and Next Steps - Urology

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It sounds like you've been dealing with a challenging situation regarding your ureteral stones and the associated symptoms. Based on your description, you have undergone multiple sessions of extracorporeal shock wave lithotripsy (ESWL) since July, and while you have passed some small fragments, you are still experiencing significant discomfort and symptoms that are concerning.


Understanding Your Symptoms
The symptoms you are experiencing, such as tightness and pain in the left flank and abdomen, could be related to several factors:
1. Residual Stones: Even after ESWL, it's possible that small fragments of stones remain in the ureter or kidney. These fragments can cause irritation and inflammation, leading to pain and discomfort. The fact that you have had a slight hydronephrosis (swelling of the kidney due to urine buildup) suggests that there may still be some obstruction or irritation present.

2. Muscle Tension and Spasms: Chronic pain and discomfort can lead to muscle tension in the surrounding areas, which might explain the tightness and pain you feel in your back and abdomen. This tension can also lead to referred pain, where discomfort is felt in areas away from the actual source of the problem.

3. Nerve Irritation: The presence of stones or inflammation can irritate nearby nerves, leading to sensations of pain or discomfort that may not directly correlate with the location of the stones.

4. Other Conditions: While your symptoms are likely related to the ureteral stones, it’s also possible that other conditions, such as intercostal muscle strain, rib dysfunction, or even spinal issues, could be contributing to your discomfort.


Next Steps and Recommendations
Given your ongoing symptoms, here are some recommendations:
1. Follow-Up with Urology: Since you have a history of ureteral stones and are experiencing persistent symptoms, it would be prudent to follow up with your urologist. They may want to perform additional imaging studies, such as a CT scan, to assess for any remaining stones or complications that may not be visible on ultrasound.

2. Pain Management: Discuss your pain management options with your healthcare provider. They may recommend medications to help alleviate your discomfort, including anti-inflammatories or muscle relaxants.

3. Physical Therapy: If muscle tension is contributing to your symptoms, a referral to a physical therapist may be beneficial. They can provide exercises and techniques to relieve tension and improve mobility.

4. Monitor Symptoms: Keep a detailed log of your symptoms, including when they occur, their intensity, and any activities that exacerbate or relieve them. This information can be valuable for your healthcare provider in determining the best course of action.

5. Consider Other Specialists: If your symptoms persist despite urological evaluation, you might consider consulting with a pain management specialist or a physical medicine and rehabilitation (PM&R) physician. They can provide a comprehensive approach to managing chronic pain.


Conclusion
In summary, your ongoing symptoms could be related to residual stones, muscle tension, or other underlying conditions. It’s essential to maintain open communication with your healthcare providers and advocate for further evaluation if your symptoms do not improve. Regular follow-ups and appropriate imaging can help ensure that any remaining issues are addressed promptly. Remember to stay hydrated and follow any dietary recommendations provided by your urologist to help prevent future stone formation.