(URETEROSCOPY) URETEROSCOPYdalelaacademy.in/Content/Pdfs/Pdf4593.pdfMr. Jai Prakash Mr. Ankit...

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URETEROSCOPY (URETEROSCOPY) Dr. D. Dalela URO-HEALTH EDUCATION CELL URO-HEALTH RESEARCH CENTER, LUCKNOW of ureteric calculus E ndoscopic treatment PDF Compressor Pro

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Page 1: (URETEROSCOPY) URETEROSCOPYdalelaacademy.in/Content/Pdfs/Pdf4593.pdfMr. Jai Prakash Mr. Ankit Mehrotra Publishers Triveni Educational Publishers Lucknow Printer Maruti Scanners, Lucknow

UR

ETE

RO

SC

OP

Y

(URETEROSCOPY)

Dr. D. Dalela

URO-HEALTH EDUCATION CELLURO-HEALTH RESEARCH CENTER, LUCKNOW

of ureteric calculus Endoscopic treatment

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First Edition-2010

Composing & DesigningMr. Sanjay Kumar

Smt. Urmila Shukla

ArtMr. Jai Prakash

Mr. Ankit Mehrotra

PublishersTriveni Educational Publishers

Lucknow

PrinterMaruti Scanners, LucknowMob. : 9839055651

Book Cost Rs. 250/-

Uro-Health Education Cell

Uro-Health Research Center

2/503, Vikas Nagar, Lucknow

Tel. : 0522-2768899, 2768850

Fax : 0522-2768752

Email : [email protected]

Dr. Divakar Dalelac

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(URETEROSCOPY)

Uro-Health Education CellUro-Health Research Center, Lucknow

A patient guide book

MBBS, MS (Surgery),Mch, (Urology), FICS (Urology), FAMS (Urology),

Dr. D. Dalela

Dept. of Urology, CSM Medical University(Erstwhile KG Medical College)

Lucknow

Professor & Former Head

Endoscopic treatment of ureteric calculus

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This book on URETEROSCOPY is an outcome of combined and

persistent efforts of many people. First of all, my patients who posed

these questions, were shown the manuscript of ' answers'. Their

valuable suggestions added simplicity & clarity to answers. My father

Dr. R C Dalela, who him self is a renowned author and editor of

leading internal journal, continuously encouraged me to do this

work. My all teachers, M.Ch. students, departmental colleagues have

been source of information and inspiration. My wife Dr. Abha, son

Deepansh and daughter Disha looked at the manuscript at various

stages, Dr. Shuaibul assisted the process of translastion Mr. Jai Prakash

& Mr. Ankit Malhotra made illustrations. Mr. Sanjay kumar and Mrs.

Urmila Shukla composed & designed the book and Mr. Sunil Baijal

brought the book is present shape by printing it . If my book is

appreciated by the patients and professional colleagues , the credit

should go to all these people.

Acknowledgements

-D. Dalela

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Dear Sir/Madam,

You have been suffering from the stone in

your ureter for long and now you have decided to

undergo the operation endoscopically for the

same.

This book is aimed to satisfy all your queries regarding the operation, your

postoperative period in the hospital and life after operation. To make this book

universally appealing, a number of complications and side effects have been

mentioned here–but it does not mean that you are going to have any or all of these

problems. These are just written with the intention that in case you develop any of

them, you will know beforehand how to handle them and you will not worry for it.

We are bound to give the best results of your operation and hope that, our

effort of imparting you all the knowledge regarding your operation will benefit you

in overcoming all your doubts and help in speedy recovery.

With regards

Divakar Dalela

A cell dedicated to disseminating scientifically validated knowledge to patients and medical colleagues for improving standards of Uro-Health Care

What is the need of this book?What is the need of this book? ??

Uro-Health Education Cell

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CONTENTSCONTENTS

1. Stone impacted in ureter–Why it should be treated?

3. Which patients are suitable for this operation and which not?

4. What precautions to take before operation?

2. How is this operation done?

9. What dietary precautions should you take afterwards?

10. When to meet the doctor?

5. Which type of anesthesia is used for the operation?

6. What can be the complications of the operation?

7. What can happen to you after the operation?

8. What should you do after being discharged?

01

03

06

08

10

11

15

17

19

26

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Kidneys are important part of our excretory system. The urine

formed in the kidneys is drained into the bladder via a thin tube. This tube is

called ureter in medical language. Stone formation in ureter is a common

disorder. Most small stones pass off spontaneously but some big ones get

impacted in ureter thereby creating blockade in urine flow resulting in swelling

of the kidney and thus harm patients in various manners.

When a stone gets impacted in the ureter, the patients feel severe pain

starting from one side of the flank towards the center of the abdomen

sometimes, this pain can be unbearably severe

Many patients feel nausea or vomiting along with the pain. The frequency

of urination is increased and there may be blood in urine occasionally. All these

problems hamper the daily activities of the patient. Medications sometimes

help in decreasing the pain but the pain can reappear any time.

Rough surfaceof stone induces

bleeding from ureter

Stone in ureter

1

The ureteric colic strats from Loinand goes towards groin

Stone impacted in ureter–Why it should be treated?1

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If this stone remains

impacted in the ureter, the

kidney might swell up due to

blockade in urinary flow

resulting in decrease in

function of kidney.

If these type of stones block both the

ureters, patient may stop urination at once

resulting in the increase of dangerous

products, such as urea and creatinine in

blood. The patient may eventually need

dialysis to get rid of this problem.

Some patients may develop infection in

the stranded urine in the kidneys. The patient

may experience high grade fever along with

chills. If this stone and the resulting infection

is not treated promptly, this infection may

spread in whole body and can be fatal

sometimes. Fever with chills isa serious symptom

2

Stone stuck in the ureter

Blockade of ureter leadsto hydroureteronephrosis

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This operation is done with the help of a specialized

endoscope called “Ureteroscope”. This ureteroscope along with its

accessories is passed inside your urinary tract. No new opening or hole is

made in you body.

rI n t h i s ope ra t i on , t he

ureteroscope is passed inside your

urinary tract till the level of stone.

The doctor constantly watches the

progress of ureteroscope on a

video monitor and the stone is

broken into small pieces using a

specialized Laser or pneumatic

wave machine. Most of the stone

fragments are taken out with the

help of a forceps passed through

the ureteroscope. The smaller

fragments pass out in urine

afterwards spontaneously.

3

Stone impactedin ureter

Ureteroscope

Laser wave disintegrating

the stone

How is this operation done?2

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rAn advanced X-ray machine called C-arm is used in this operation to

constantly watch the real time position of stone and also the progression of the

ureteroscope inside. X-rays are intermittently projected on your abdomen and

pelvis. These x-rays are usually of low power so that they don't produce any

untoward effect on your body.

4

C-arm

Surgeon passing the ureteroscopethrough urinary passage

The endoscopic view of stone isseen on a video monitor

The patient lying on operation table underthe C-arm machine

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rTo settle the swelling of kidneys, a thin silicon coated tube called D-J

Stent, is also put inside from the kidneys till bladder. Sometimes another tube

called as “Ureteric Catheter” is placed instead of DJ Stent. Your doctor decides

about the type of tube to be kept inside your ureter.

rSome patients are also required to be

catheterized to drain out the urine from the

bladder. This catheter is removed after 24 to 72

hrs. Your doctor will decide the right time to

remove your catheter.

rThe total time taken for the operation may be one to two hours- this

depends upon size, hardness and degree of impaction of the calculus in

ureter. Some increase in duration of operation should not alarm you.

5

A stone impacted inright lower ureter

A DJ stent is kept in the diseasedureter to let it take rest

Schematic diagram oflocation of DJ stent

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6

The ureteroscopy operation is not suitable for all patients.

Your doctor is able to know this fact beforehand by analyzing your

investigations. So please cooperate in getting all the investigations done such

as Intravenous Pyelography, CT Scan or Urine culture as and when advised.

Which patients are suitable for the operation and which are not is

explained below. Let your doctor decide what technique is suitable for you. If

your doctor decides to go ahead for the operation inspite of the problems given

below then also there is no difficulty in doing so, becaus this depends upon the

personal experience of the operator.

so that it can be broken and all fragments

can be taken out within a stipulated time.

so that the endoscope

is not needed to be passed to a greater height.

like complex urethral stricture or severely

enlarged prostate gland.

ü

ü

ü

Stone size is less than 1cm

Stone is situated in the lower part of the ureter–

No blockade or disease in urethra or urinary passage that hampers

the passage of endoscope

The hydrouretero-nephrosis (ditation of

ureter & kidney) due to the blockade

by the stone

A stone lying in right lower ureter

Which patients are suitable?

Which patients are suitable for this operation

and which not?3

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7

û

û

û

û

û

impacted so that there are little chances of success in this operation.

There are technical

difficulties in taking the rigid endoscope to this level. However, flexible

ureteroscope can easily reach upto the kidney.

which have

resulted in the structural changes of these organs.

particularly if pregnancy duration is less than 6

months.

Stone is larger in size –

Stone is situated in the upper part of the ureter -

Any previous complex surgery of the bladder or urethra

Patients who are receiving anti-clotting medications (e.g. Aspirin or

clopidrogel) in high doses due to previous heart or brain illness.

Pregnant women -

Some stones are really hard, very big and

Which patients are not suitable?

A very big stone impactedin ureter

Dilatation of ureter as a resultof blockade of ureter

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8

The endoscopic removal of stone is a highly technical

operation. You have to do some preparations before this:

1. If you are taking any anti-clotting medications such

as Aspirin, tell your doctor about it. You may need to stop

these medications five to six days prior to surgery.

2. If you are suffering from any urinary tract infection

and your doctor has advised antibiotic medications for

the same, please continue taking them.

3. If you are suffering from constipation, do tell your

doctor about it and start medications for the same. It

would not be advisable to strain for passing stools

after operation so it is better to cure your constipation

before it.

4. If you are suffering from bouts of cough along

with sputum, ask for medications for the same.

Taking medications and a little steam may safeguard

you from many problems after the surgery. If you are

a smoker, it is advisable to quit smoking completely

before the operation.

Asprin

Antibiotic

Constipation

What precautions to take before operation?4

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5. It you are taking any anti-hypertensive

medications, do tell your doctor. If you have

been restricting your salt intake to regulate your

blood pressure, do tell your doctor. It is better to

get your blood sodium level checked before the

operation.

6. If you are allergic to any medication, please tell our doctor.

7. If you have suffered from any disease previously such as–Diabetes,

Asthma, Epilepsy, Jaundice, or if you have undergone any operation in the

past, do tell your doctor. If you have suffered from any complications during

that operation, inform your doctor in detail and also show the records of that

operation.

8. During the operation your stone and its fragments are seen on the C-Arm

machine utilizing X-rays from it. So it is important that your abdomen is free of

gases or any stool. For this you need to take certain precautions one to two

days prior to surgery.

nAvoid intake of oily, spicy and non-vegetarian food.

nTake the following medications as advised:

i. Tab GASEX 3 tablets three times a day.

ii. Tab FERIZYME or UNIENZYME one tablet three times a day.

iii. Tab LAXICON or GUDLAX two tablets / Syp LACTULOSE 15ml at

bed time.

9. Just a day prior or on the day of surgery, the recent status of your stone is

confirmed with the help of a plain X-Ray KUB.

9

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This operation is performed by giving anesthesia by an

injection into the backbone which numbs your lower body and patient doesn't

feel pain at all.

General anesthesia is required in some patients like young babies or girls

or patients in whom giving injections in backbone is not possible.

Few urologists advise to give general anesthesia to all patients. You can

discuss with your doctor about this and it is better to decide about it before

hand as per your needs.

If you are given anesthesia in your back, it is advisable to relax in bed for a

day otherwise you may have some backache or headache from the next day,

patient can resume walking. This is not required if you have been given

general anesthesia.

10

Anaesthetist pricking into the backbone a very fine needle

Anaesthetizing drug is injectedthrough this needle

Which type of anesthesia is used for the operation?5

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All operations, especially endoscopic, are performed on

patients after extensive research but sometimes due to unforeseen problems,

or due to complexities of the disease, there can be some technical

complication during or after the operation. Just for your information, we are

discussing these problems here – this is not to horrify you but the sole purpose

of discussing these here is to ensure you that your doctor knows well about

them and is well trained to tackle these complications. Your patience and

confidence will help your doctor in performing the operation well.

As told earlier that in this operation we insert an endoscope into your

ureter and break the stone impacted in it and then remove its fragments.

There may be some complications in the first phase of the operation – In

which we insert the endoscope into your ureter–which are discussed below:

In some patients, when the stone is impacted in the ureter for a longer

period, the mucous surface beneath the stone gets swollen resulting in

decreased girth of the lumen of the ureter thereby

making it difficult for the endoscope to reach up to

the stone. This swelling on the mucous surface is

due to the following factors– The kidney pushes the

stone continuously in order to expel it out.

Consequently, the pressure inside the kidney

increases and the ureter makes stronger attempts

1. Unable to reach up to the stone:

11

Some swelling in wall of ureter, below

the stone

6 What can be the complications of the operation?

Complications during the first phase of operation

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to push the stone down thus contributing to

worsening of swelling of mucous membrane. If

anyhow this pressure can be decreased, the

ureter will stop pushing the stone and the swelling

of lining surface of ureter will decrease. So in this

situation, the doctors place a thin tube called DJ

Stent inside the ureter. This stent is placed

between the kidney and the bladder by the sides

of the stone and drains the stranded urine from

the kidneys directly into the bladder. The

pressure in the kidney reduces shortly after

placing this stent and the constant pushing down

of the stone also stops. Usually, after 3-5 days of placing the stent, the swelling

over the mucus surface subsides and it is possible to go in once again to reach

up to the stone by endoscope.

The end of the ureter which opens in the bladder is very narrow in some

patients (5-10% only). The ureter opens via a small opening into the bladder,

called ureteric orifice. In order to insert the endoscope into the bladder, we first

dilate this opening which is very easily done in all patients. But sometimes this

very narrow opening doesn't dilate enough even after various attempts. This

narrowing can be due to the swelling over the ureteric orifice which can not be

predicted beforehand. In this case, doctors place a DJ stent as described

above and this narrowing dilates slowly in 3-5 days and it is possible to go in

again to reach up to the stone by endoscope.

In the second phase of operation after reaching up to the stone, we

2. Unable to enter into ureter through the ureteric orifice:

12

DJ stents placed on both sides to de-block the ureters

Complications during second phase of operation

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break this stone into smaller fragments using special waves. There may be

some complications in this phase too:

In some patients the

and takes a lot of time to break. In this

situation only a small part of the stone is

possible to remove and the rest of the stone is

broken at a later date by repeating the same

procedure.

In some patients, if the

or if it is impacted in the flesh of the ureter, then

the whole stone is not possible to be removed in

one sitting. In this situation we remove some of

the stones and place a DJ stent inside and we

do a second sitting of the operation after some

days and remove the remaining fragments of

the stone.

In some patients who have severe hydroureteronephrosis, some

fragments of stone migrate upwards in the kidney which pass out

spontaneously afterwards with the help of the DJ stent. In few patients

lithotripsy may also be needed to break the bigger stones into smaller

fragments, which may pass spontaneously through urinary passage. Some

patients require PCNL.

1. Unable to break the whole stone:

2. Some fragments of stone migrate upwards in the kidney:

stone is extremely

hard

stone is very big

In this way patients having big and

impacted stones are also benefitted with the

ureteroscopic operation and avoid open

surgical operation.

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3. Injury to the mucosal surface of the ureter:

In some patients, due to the impaction of the stone for a long period of

time, the walls of the ureter become friable and they may get injured during

ureteroscopic procedure. In this situation, the wounds of the ureter get healed

spontaneously with the help of placing DJ stents for a longer period of time.

You must have observed that there is a similar solution to all the above-

mentioned problems i.e: placing the DJ stent inside the ureter. This is an

extremely useful technique for the ureteroscopic procedure. We can tackle the

mentioned complications easily with the help of DJ stent.

The ureteroscopic removal of stone is the most popular operation done

at all the urological centers worldwide and it is successful in more than 90% of

the patients. Only in 10% of the patients, the complications which were

discussed earlier may happen but they can also be tackled easily.

Normally, all patients with simple stones can be treated with

ureteroscopy. Large, hard and complicated stones, which needed open

operations previously, can also be treated in two sittings of the ureteroscopic

procedure as discussed above.

It is usually seen that when we explain to the patients about the

complications happened during the procedure and plan the second sitting of

the procedure the patients appear slightly disappointed. This thinking is not

good. Every patient is different in terms of his disease, his stone, the anatomy

of his kidneys and ureters, and your doctor has to customize the procedure

depending upon the complexities of your disease.

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1. If you have been given anesthesia by an injection given

in your lower back, its better for you to lie down in bed for at least a day.

Your doctor may also instruct you to avoid a pillow under your head. The

numbness in your lower half of body may take 2-3 hours to wither off. So

please don't panic.

2. You may develope fever along with

some shivering just after returning from

operation theatre. This may be due to

the glucose infusion given intravenously

or may be due to the saline water used

for cleaning the blood clots or stone

fragments during the operation or it may

be due to bacterial reaction present in you before hand. Don't panic, the

nurse will give you injections of Avil or Hydrocortisone or Tramadol,

which will make you fine very soon.

3. There will be a catheter placed in your

urinary passage to ease out passage of

urine. You may feel some heaviness or

burning in the urinary passage or pelvic

area. You may also feel episodic

increase in desire to urinate. There may

be slight spillage of urine alongside the

catheter along with some burning or discomfort. Please don't panic, this

will also settle down with rest and proper treatment.

7

15

What can happen to you after the operation?

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4. After the stone has been removed, the turibid urine collected in the

kidneys drains out leading to mild fever along with shivering. This will

also settle in 2-3 days with the help of proper antibiotics.

5. The urine coming from the catheter

inserted in the urinary passage may

sometimes be red in colour. This is due to

mild blood oozing from the urinary

passage. This also gets cured in 1-2 days

spontaneously.

6. You are allowed, 2-3 hours after the

operation, to have something to drink or

light meals like biscuits to eat, but please

discuss this with your doctor prior to starting this.

7. The catheter placed in the urinary passage is removed after 24-48 hours

and the patient is discharged from hospital and sent home.

8. The DJ stent which is placed inside remains there for two-three weeks.

This stent is fully inside the body and no part of it is visible from outside.

This stent doesn't make any difficulty in moving, eating, doing daily

activities or doing sex. Sometimes the patient may feel some burning in

urination, mild fever or some blood in urine. This settles down in few

days with medications. Don't forget to fix the date for the removal of this

DJ stent at the time of your discharge from the hospital.

16

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Continue your daily routine

activities normally.

v and pass urine

frequently. This will help in removal of

small fragments of stones and blood

clots easily.

vDue to the DJ stent placed inside, you

may feel some pain during urination.

This will get healed spontaneously by

passing urine frequently in two-three

days.

v For this you should

increase green vegetables, Salads,

and fruits in your diet. Don't strain much

in passing stools.

v that

have been prescribed to you. Please

don't make any change in the dosages

of the medication by your self.

v

The abdominal straining may result in

undue problems by the DJ stent as it

may irritate your bladder.

Drink lot of water

Avoid constipation.

Continue taking all the medications

Don't try to lift or carry heavy weights.

8

17

What should you do after being discharged?

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vAvoid long and strenuous travel as this may result in displacement

of the DJ stent placed inside and there may be some blood in urine.

If you experience this please do take bed rest and increase your

water intake, this will settle down by it self.

vThe males may continue sex with their partner while the DJ is

inside. The females may experience some pain during sex while

the DJ is inside. With mutual understanding for sex this discomfort

may be decreased.

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The kidney stones can be prevented to a greater extent by

modifying your diet. The genetic and geographical causes however, can not

be modified.

The simple measures through which the stones can be prevented are as

follows :-

The treatment of the stone disease starts with the increased intake of

water. The water can be taken in different forms such as fruit juices, coconut

water, juices or tea. Drinking large amount of water results in dilution of urine

and the concentration of the constituents responsible for stones is thus

decreased. The acidity of urine also decreases with increased water intake.

The concentration and acidity of the urine results in formation of stone crystals

and by increasing the water intake both of them can be checked. Now the

question arises how much water should we drink daily?

Those people who do extra physical work and who sweat

out a lot should aim to drink at least 5 liters of water daily.

It has normally seen that patients who are advised

to have more water usually drink a lot of water during

day time but after going to bed they only drink water as

they get up in the morning. Morever, if the patient is

sleeping in a warm environment, there may be a depletion of water from body

You can take at least 3-4 liters of water daily and you must keep in mind that

your urine should be diluted and should be of light color

and you should pass at least 2 liters of urine everyday.

9

19

What dietary precautions should you take

afterwards?

DRINK LOT OF WATER

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in from of sweat which results in increased concentration of the urine by the

morning. Along with it, when the person sleeps the kidneys, ureters and the

bladder come in a same horizontal level so the urinary flow from the kidneys to

the bladder rather slowly.

So by this routine of getting up for

one to two times in a night the urine stranded in your kidneys drains out under

gravitational influence and if some small crystals have formed they also get

cleared along with urine.

The citrate present in

lemon is helpful in prevention of stone. Don't mix extra salt as

this may help in stone formation.

These

help in reducing the acidity of the urine and along with that the

water content in them increases the urinary output and

decreases the concentration.

The orange juice contains citrate which alkalises the urine

and also helps in preventing adhesion of small stone crystals.

qOn you doctor's advice you can have 3 tablespoon of

in a glass of water for three times a day. This definitely

helps in prevention of stone.

The fresh tomato juice is also beneficial. The high citrate

content in this prevents stone formation. In our society, there is a

lot of misconception about tomatoes. These misbelieves often

restricts the intake of tomatoes in stone patients.

So to prevent the formation of stones you should

drink one or two glasses of water before going to bed and also drink a glass of

water when you get up in the night to urinate.

qLime water is most beneficial.

qCoconut and barley water are also beneficial.

qCitrus juices (Oranges etc) and pineapple juice are also

beneficial.

Potassium, Magnesium citrate and with pyridoxine mixed

syrup

q

20

Which drinks to take in large amount?

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You have to restrict the food products which contain constituents that

promote stone formation. Please remember that you have to only restrict

these products not absolutely leave them.

21

Which food products to restrict?

Food products rich in calcium

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Barley Curd

Sweets

Calcium containing supplements Calcium Tablets

Food products rich in oxalate

dktw phdw pkdysV

ikyd vk¡oykpqdqUnjSpinach Beetroot

Cheku

Indian goose berry (Amla)

Cashewnut Chocolate

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You should consume a limited amount of the products containing oxalic

acid, calcium, purine and phosphate as described above. By restricting the

amount of the product containing constituents that make your stone,

you may prevent recurrent stone formation in the future.

Particular restrictions on these items in dinner and sleeping in a

comfortable environment and waking up early are also helpful in the

prevention of stone diseases.

22

dsyk cknke e'k:eAlmonds

BananaMushroom

eqxZeNyh xks'rFish ChickenMeat

Food products rich in phosphate

Food products rich in purine

All patients of stone disease should restrict

these products in their diet.

nAll food products containing high amount of proteins.

nSalt to a minimum.

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Don't separate barn from flour. The phytate found in

the barn helps in sequestration of the oxalate and

hereby prevent the formation of the calcium

oxalate.

Increase all type of fruits in your diet (only excluding

fruits containing high oxalate contents such as

berries).

Bitter gourd is helpful. The magnesium found in this

is helpful in prevention of stones

Eating fresh carrots is also helpful. The vitamin A

found in this is helpful in stone prevention in some

patients.

Avoid all cola drinks, preserved drinks, excessive tea and coffee.

Some patients find the water of some pulses (Kulthi) helpful in stone

diseases. But keep in mind that excessive intake of this type of liquid can

harm your body.

23

Which food products to increase?

Which drinks to avoid?

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Some people in society advocate high intake of Beer

for stone patients. Please don't fall in this trap as some

preservatives in beer can increase your blood uric

acid levels thereby increasing the chances of stone

formation.

The apple juice found in market and also artificially

flavored soft drinks have high oxalic acid contents. So

it's better to avoid them.

If you are habitual of taking milk and you have calcium

oxalate stones, then it's better not to take more than 2

glasses of milk a day.

The changes in diet are advised according to the chemical

composition of the stone.

24

Which food products to avoid in which type of stones?

Stone of calcium oxalate

Products high in calcium such as dairy products,

Tablets of calcium and Vitamin D, and high oxalate

products such as spinach, chocolate

and ground nuts

Stones of uric acid Meat, Liver, Chicken, Fish, Mushroom etc.

Stones of Cysteine Food products high in Methionine such as

Cod Fish, Mushroom and Cauliflower.

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We hope that this much information is enough for you to understand that

what is the ideal food for you and what is the balanced diet, which provides

essential elements for your body as well as which prevent stone formation. All

the food products are essential for us, and if we are restricting some of the

products then it is absolutely necessary to take a balanced diet so as to

prevent deficiency of these items in near future. It is better to consult your

dietician or endocrinologist over this issue.

25

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1. Please take care of the DJ Stent placed inside you.

Please come for its removal on the date as advised by your doctor. This

stent is removed by desensitizing the urinary passage with the help of the

cystoscopy (Endsocopy of the urinary tract). You can leave for home

immediately after removal of this stent. Before coming for the stent

removal please get an X-Ray KUB and bring this as well as all the

previously done X-rays along with you.

2. If you get any of the below mentioned symptoms at home after your

discharge from hospital, immediately consult your doctor.

10

26

When to contact the doctor?

Continuous passing of red colored urine

High grade fever with chills and rigors

Severe pain on the side of operation

Scrotal swelling and pain

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3. Get an IVP or DTPA Scan done after 3 months of operation so as to know

about the functional improvement of the kidney.

4. Get an ultrasound at regular intervals in future so as to check reformation

of stone if any. You can also get some blood and urine investigations as

advised by the doctor.

5. If you experience any decreased flow of your urinary stream in future,

consult your doctor. This can happen due to some stricture formation in

your urethra and early detection and treatment of this can save you from

its complications.

6. If you have sent the stone to a lab for its evaluation, please show that lab

report to your doctor so that he may give you advise regarding the

prevention of the stone formation.

Stone impected in the ureter Recovery of kidney after clearance of stone

27

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Dr. Divakar DalelaFormer Head, Department of Urology, CSM Medical University

Erstwhile King George Medical College

Lucknow

Prof. D. Dalela is an internationally renowned Urologist,

committed to spreading the Urological knowledge not only amidst

medical students but also amongst the nursing community,

practitioners of alternative medicine, paramedical personals and

patients.

He entered K.G. Medical College Lucknow as medical graduate in

1979, and gathered 18 gold medals and 6 silver medals during MBBS. He was awarded the

prestigious Hewett gold medal in the year 1983 for being the topper of his batch. He completed

his M.S. (Surgery) from K.G. Medical College in year 1987-88 and then proceeded to Sanjay

Gandhi Post Graduate Institute of Medical Sciences, Lucknow to obtain M.Ch. Urology

degree in 1991-92. Ever since, he has been working as a faculty member of K.G. Medical

University and is credited with establishing a fully equipped Dept. of Urology during his

Headship. His penchant for research is equally strong. He has published over 110 research

papers, innovated 15 specialised urological operating techniques, innovated three urological

instruments and developed many urological softwares. He has written 13 patient education

books and 12 pamphlets in Hindi, and the Hindi version of this book on catheter has been

awarded Third Prize by ICMR in 2008 as the “Best Popular Medical Book.” He has travelled to

over ten countries to present his research work in various conferences and has been

Operating Faculty in many live operating workshops. He was elected as fellow of National

Academy of Medical Science in 2009.

Dr. Dalela is very popular amongst his students as a teacher in urology, and by his

efforts, his department is already a frontrunner for its contributions in national and

international urology.

URO-HEALTH EDUCATION CELLURO-HEALTH RESEARCH CENTER, LUCKNOW

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URO-HEALTH EDUCATION CELLURO-HEALTH RESEARCH CENTER, LUCKNOW

2/503,VIKAS NAGAR, LUCKNOW

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