radiation question, possible kidney stones.

[Jewelrylady]

my husband had SBRT (prostate, few spots on spine, and one rib) in August and November 2023 with no side effects. He recently had lab work and It showed blood in urine, high protein, and crystals. He had an ultrasound to rule out kidney stones and it showed nothing so he is now scheduled for a Uro CT scan with contrast to make sure no kidney stones. He has had kidney stones in the past and that’s what it has felt like (low back pain). Is this too much radiation? Is this too soon after SBRT? Has anyone had a CT scan after having SBRT? Any problems? Thanks.

[Nusch]

I’m not a doctor but if I would be in this situation Inwould go for CT. It’s a matter of priority.

[Tall_Allen]

No problem. CT is a drop in the bucket compared to his SBRT. Just avoid cystoscopy.

[Jewelrylady in reply to Tall_Allen]

CT scheduled in a few weeks.

[daysbetween in reply to Tall_Allen]

What is the risk of cystoscopy ? I was diagnosed with a kidney stone over the weekend, and they talked about going in through a catheter to "grab it" if I didnt pass it.

[Tall_Allen in reply to daysbetween]

The risk is that the urethra tissue is friable from the radiation and prone to tearing from instrumentation.

[daysbetween in reply to Tall_Allen]

Is that a condition that is permanent ? I have been through SMRT and LDR Brachy back in 2018.

[Tall_Allen in reply to daysbetween]

No- tissues strengthen over time.

[Jewelrylady in reply to daysbetween]

What did you decide to do about your kidney stone. The doctor talked to my husband about having a ureteroscopy.

[daysbetween in reply to Jewelrylady]

I passed my kidney stone last friday so no procedure was necessary.

[Jewelrylady in reply to daysbetween]

Lucky you! I hope it wasn’t too painful.

[daysbetween in reply to Jewelrylady]

Most of the pain had come before my post as the stone worked it's way down my ureter. The last step before passing was more relief than anything else.

[Jewelrylady in reply to daysbetween]

My husband has 3 stones. 3mm in one ureter, 6mm in other ureter and one in kidney. All nonobstructing. The procedure to get them out makes me nervous!

[daysbetween in reply to Jewelrylady]

Tell him drink water and then drink some more ! I just about doubled my water intake prior to passing the stone

[Seasid in reply to daysbetween]

Some just simply drink beer? Or does it depend about the chemical composition of the stone? Someone did that 40 years ago. I still remember that.

[Seasid in reply to Seasid]

Try to catch the sample with a small Tea mesh and send it to the laboratory for analysis. Probably you are passing much more sand Than you think because they are not visible on your scans but if you are using a fine tea mesh then you can see better what is going on than with any scans? I am not a doctor but wish you all the best.

[Seasid in reply to Seasid]

Best to use a light plastic mesh so you can always carry with you.

[j-o-h-n]

If he had stones before........... he knows the pain............. I've had several right and left....and I know the pain........If stones, hopefully he passes them/it quickly. Try jumping up and down (or ride a horse) to help dislodge the stone(s). Plenty of water..... and more water and more water and some cranberry juice.....

Good Luck, Good Health and Good Humor.

j-o-h-n

[Ab75]

How is his kidney function? I had a ct scan earlier this year with contrast and I have protien in my urine since the scan. If his kidney function is degraded I would inquire about the contrast.

[Jewelrylady]

UPDATE: husband had urinalysis today and there were several abnormal results: Protein - Trace. Last time it was 1+; Blood 2+, last time it was 3+; WBC 3-5 abnormal, last time it was 0-2; RBC 11-20 abnormal, last time >50. Any thoughts or interpretation of urinalysis and CT is appreciated. He won’t meet with urologist until next week. It looks like he does have some kidney stones, but are they bad enough to do something now?

He also had CT with contrast:

1. Non obstructing stones in the distal left and right ureters, and nonobstructing stone in the lower pole left kidney are likely sources of microscopic hematuria.

2. Prostate cancer status post radiation treatment, and circumferential urinary bladder wall thickening from radiation treatment effect and/or outlet obstruction are additional potential sources of hematuria. These are grossly unchanged from the PET CT in June 2023. No obvious extraprostatic spread or distant metastasis.

Kidneys: Demonstrate symmetric nephrograms and excretion. Punctate nonobstructing stone in the lower pole left kidney. 3mm no obstructing stone in the distal left ureter. 6mm nonobstructing stone in the distal right ureter. There is no hydronephrosis. There are right renal cysts and is 6.5 cm left renal cortical cyst. The left and right ureter is completely opacified. There are no soft tissue masses in the renal collecting systems or ureters.

Bladder/Pelvis: circumferential urinary bladder wall thickening. Suble 1.9cm hypoenhancing region in the left posterior peripheral zone corresponding to prostate cancer found on PET. Radiation fiducial markers in the prostate.

Everything else was unremarkable.

[Seasid in reply to Jewelrylady]

ChatGPT :

It seems like your husband is dealing with a complex situation involving both his prostate cancer treatment and potential kidney issues. Here are some points to consider based on the details you’ve shared:

1. **Kidney Stones and Radiation:** The CT scan confirmed the presence of non-obstructing stones in both ureters and a stone in the lower pole of the left kidney. The presence of blood in the urine (hematuria), protein, and crystals, along with his history of kidney stones, suggest that these stones might be contributing to his symptoms. While the kidney stones are small and non-obstructing, they could still be a source of discomfort and the abnormalities seen in the urine tests.

2. **Radiation Effects:** The circumferential urinary bladder wall thickening and changes in the prostate area are likely related to the radiation treatment. Radiation can cause inflammation and fibrosis of tissues, which could explain the bladder wall thickening. This thickening could also contribute to the blood in the urine.

3. **Contrast in CT Scans:** Given his previous kidney stone history and current kidney function (as indicated by protein in urine), the use of contrast in CT scans could pose a slight risk. Contrast agents can sometimes impact kidney function, especially if there's pre-existing kidney damage. However, the scan was necessary to provide a clear picture of what might be causing his symptoms.

4. **Urinalysis Results:** The urinalysis results show a reduction in the severity of abnormalities compared to previous tests, which could indicate a slight improvement or stabilization of the underlying condition. The trace protein and reduction in blood levels (RBCs and WBCs) could suggest that while there is still some kidney irritation or mild damage, it may not be worsening significantly.

5. **Next Steps:** The urologist may consider the benefits of managing the kidney stones now versus a "watchful waiting" approach, especially since the stones are non-obstructing. The decision will likely hinge on the severity of symptoms and the risk of the stones becoming obstructive or causing more severe issues in the future.

6. **Bladder Wall Thickening:** The bladder wall thickening is consistent with radiation effects, and it's important to monitor this over time to ensure it doesn't lead to more significant urinary symptoms or complications.

It’s good that the upcoming appointment with the urologist will provide a more comprehensive interpretation and plan. They might discuss options like increased hydration, dietary changes to prevent further stone formation, or even procedures if the stones become symptomatic.

Overall, while the situation is complex, it seems manageable with careful monitoring and follow-up.

[Jewelrylady in reply to Seasid]

Thank you. He had surgery to remove kidney stones and he’s fine now. He did not need stents.

[Seasid in reply to Jewelrylady]

Surgery for kidney stones is generally needed if stones are too large to pass on their own, are causing severe pain, or are obstructing the urinary tract, potentially leading to infection or kidney damage. There are a few surgical options depending on the size, location, and type of stones:

1. Shock Wave Lithotripsy (SWL): The least invasive option, SWL uses sound waves to break up stones into smaller pieces that can then pass through urine. It’s generally an outpatient procedure, and no incisions are required.

2. Ureteroscopy: This is a minimally invasive procedure in which a thin tube (ureteroscope) is passed through the urethra and bladder to reach the stone in the ureter or kidney. Lasers or other tools are used to break up the stone, which can then be removed. Stents (small tubes) may sometimes be placed temporarily to help the urine flow and to prevent pain after the procedure, but they aren’t always needed.

3. Percutaneous Nephrolithotomy (PCNL): This is more invasive, requiring a small incision in the back to access the kidney. It’s generally reserved for very large or complex stones and is done under general anesthesia.

The decision to remove kidney stones surgically depends on factors like the size and type of stone, symptoms, and risk of complications if untreated. If the stone is small and isn’t causing severe symptoms, doctors may recommend simply increasing water intake to help it pass naturally. However, if it’s causing pain, infection, or risk to kidney health, surgery may be necessary to ensure relief and prevent damage.

ChatGPT said

[Seasid]

Q. Could we catch the stone with a small Tea mesh and send it out to the laboratory for further testing and could we somehow dissolve the cristals? Could we just drink lots of beer in order to dissolve the formation of further cristals?

A. Catching the kidney stone and sending it for analysis, as well as managing the crystals, can be helpful in determining the best treatment strategy. Here are some thoughts on your questions:

### 1. **Catching the Stone with a Tea Mesh:**

- **Feasibility:** Yes, using a small tea mesh or a fine strainer is a practical way to catch kidney stones when they pass in the urine. Once caught, the stone can be sent to a laboratory for analysis to determine its composition. Knowing the stone's makeup (e.g., calcium oxalate, uric acid, etc.) helps in tailoring dietary and medical treatments to prevent further stone formation.

- **Laboratory Analysis:** The lab can analyze the stone to identify its chemical composition, which is crucial for understanding why the stones are forming and how to prevent new ones.

### 2. **Dissolving the Crystals:**

- **Hydration:** The best way to help dissolve urinary crystals and prevent stone formation is by increasing water intake. Drinking plenty of fluids helps to dilute the urine, which can prevent crystals from clumping together to form stones.

- **Beer and Kidney Stones:** The idea of drinking beer to help with kidney stones comes from its diuretic effect (it increases urine production), which might help flush out small stones or crystals. However, this isn’t a universal solution. The type of kidney stone determines whether beer (or any other dietary change) might help or harm:

- **Uric Acid Stones:** Beer contains purines, which can break down into uric acid and potentially increase the risk of uric acid stones. So, beer might not be the best option if the stones are uric acid-based.

- **Calcium Oxalate Stones:** Beer might not have a direct effect on dissolving calcium oxalate stones, and other dietary adjustments (like reducing oxalate intake) may be more effective.

- **Medical Dissolution:** Depending on the stone type, medications like potassium citrate or allopurinol might be prescribed to help dissolve certain types of stones, such as uric acid stones. For calcium-based stones, dietary changes and medications to manage calcium or oxalate levels might be recommended.

### 3. **Managing Crystals and Stone Formation:**

- **Dietary Adjustments:** Depending on the stone type, certain dietary adjustments can help prevent future stones. For example, reducing sodium intake can help with calcium stones, while reducing foods high in oxalate (like spinach) can help with calcium oxalate stones.

- **Medications:** Your doctor might prescribe medications to help manage the underlying causes of crystal and stone formation. This could include diuretics, citrate supplements, or medications to manage calcium or uric acid levels in the body.

### 4. **Consulting with a Healthcare Professional:**

- It's essential to consult with your urologist or healthcare provider before making any changes, like increasing beer consumption or taking new medications. They can guide you based on the specific type of stones and the underlying cause of crystal formation.

In summary, catching the stone and having it analyzed is a great first step in understanding the best way forward. Drinking plenty of water is the most universally recommended method for preventing stone formation, and any other interventions should be guided by the stone's composition.