(URETEROSCOPY) URETEROSCOPYdalelaacademy.in/Content/Pdfs/Pdf4593.pdfMr. Jai Prakash Mr. Ankit...
Transcript of (URETEROSCOPY) URETEROSCOPYdalelaacademy.in/Content/Pdfs/Pdf4593.pdfMr. Jai Prakash Mr. Ankit...
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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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.
13
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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.
14
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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.
18
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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
dSfY'k;e ;qDr is; inkFkZ
cktjk ngh
cQhZ
dSfY'k;e xksfy;k¡
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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