Urology Meeting 25th June 2025

One of the long awaited appointments today with my new Urologist in Galway.

I have had kidney stones for many years and first properly diagnosed in 1992. Apart from the pain associated with the movement of stones they have also caused issues with treatment for CHL (Classic Hodgkins Lymphoma). Basically these little buggers can create UTI’s as they move, the UTI’s trigger blood test issues that are used in diagnosing lymph node issues – ESR (erythrocyte sedimentation rate) blood test, also known as a sed rate, is a test that measures how quickly red blood cells settle to the bottom of a test tube. It’s an indirect measure of inflammation in the body, as inflammation can cause red blood cells to clump together and settle faster. The test results can help diagnose and monitor inflammatory conditions, but it’s not specific to any one condition. However this blood test is currently one of the main indicators for lymphoma, something that we are trying to change by introducing a more targeted test called Tarc.

My ESR levels have been alarmingly high since January and basically my oncologist wants the kidney issues addressed and sorted to get a clearer idea what is happening within my lymph node system.

Thankfully the new consultant is easy to talk to and very clear in his approach.

In 1995 I had repeated procedures because a Staghead Stone measuring 24mm was found during a CT Scan. This stone was located in the upper pole of the left kidney but appeared to be within a sack in the kidney, so it was unlikely to cause issues and 30 years ago the procedure to remove the stone would have meant open surgery to the kidney, at one point in 2016 my previous Urologist was close to making that call but decided against it.

Progression in treatment for this has thankfully changed and a decision was reached today to remove the stone using a procedure called PCNL.

 PCNL, or Percutaneous Nephrolithotomy, is a minimally invasive surgical procedure used to remove kidney stones, particularly larger or complex ones. It involves making a small incision in the back to access the kidney and then using specialized instruments to break up and remove the stones. The procedure is typically performed under general anesthesia and may require a short hospital stay. 

Here’s a more detailed explanation:

• Purpose:

PCNL is a treatment option for kidney stones that are too large or difficult to remove with other methods like shock wave lithotripsy or ureteroscopy. 

• Procedure:
  • The patient is placed under general anesthesia. 
  • A small incision is made in the back, and a tube (sheath) is inserted into the kidney. 
  • Through the sheath, instruments like a nephroscope (a type of endoscope) are used to visualize, fragment, and remove the stones. 
  • X-ray or ultrasound guidance is used to ensure accurate stone location and removal. 
• Post-procedure:
  • A drainage tube (nephrostomy tube) or a stent (a tube in the ureter) may be placed to help drain urine from the kidney. 
  • The nephrostomy tube is usually removed before discharge, while the stent may be left in for a few weeks. 
  • A short hospital stay (usually 1-2 days) is typical, and patients can usually resume normal activities within a few weeks. 
• Risks:

Some potential risks include infection, bleeding, and kidney damage, but these are generally low, 

• Advantages:

PCNL is effective in removing large and complex stones and has a high success rate. 

• Disadvantages:

It is a more invasive procedure than some other stone removal methods and may require a hospital stay.

Anyway I have accepted this procedure and signed the consent form today. I am now awaiting an admission date. The consultant did say that he wanted to do this as soon as possible. It will take a 3 day hospital stay and about a 2 week recovery following surgery.

His aim is that once he removes the stone, which he intends to use a drill to break it, then they will analyze the stone to see what the stone is composed of so that they can commence managing a prevention approach. I have had stones analyzed in the past, and unfortunately they appeared to be broadly created within all 4 main types of stones. The hope is to find a better answer and then proceed to control the formation of the stones and eliminate further formations. This is a dream come through for me, people that know me know how long kidney stones have affected me.I can produce up to 30 stones a month but 99% of the time I can pass them without requiring medical help, it’s the 1% that cause issues.

Thankfully the consultant had a recent CT Scan visible on his computer monitor and I was surprised at the actual size of this stone or really rock in the kidney. It’s not just big at roughly 25mm it is also dense – the scan basically made it look as solid as a bone. If for any reason this stone moved it would completely block the kidney.

Our kidney’s average size 10 to 14 cm long and 3-5 cm wide

This is not my scan and I am only using it for illustration purposes But the position and rough size is very close to what we were shown today.

The urologist mentioned that he suspected the stone is very solid as against other smaller stones that are closer to glass and can break easily.  He basically explained all the risks associated with the procedure and expects that the actual procedure will take up to 3 hours to perform. He also has a B plan if the procedure fails, which is unlikely but good to know, the B plan would only be decided during the actual surgery. 

We also discussed the prostate – there are risks from Lymphoma for the prostate especially for Stage 4 victims. But my PSA is checked twice a year and he felt that it was in good condition. He also surprisingly mentioned that my kidney functions were good and due to this recovery should also be good. The added bonus for me is that removing the source of the UTI’s and creating a management plan to control or stop them would boost my immune system.

Both the urologist and the haematologist are in the same hospital and they have already discussed my case, I suspect that once admitted the haematologist will meet me. This procedure once completed will require a CT NTAP to confirm that the kidney is undamaged and clear, this CT Scan will also be viewed by the haematologist to check lymph nodes.     

Finally getting a move on things but not really what I expected. After living with these little buggers for 30 years it would be great to continue without them and still have both kidneys. Yes there is a risk associated with the procedure but I can accept the risks.

PCNL has been in use since 1976 but my previous urologist never suggested it. The new urologist specialises in kidney stones and has used this procedure for years.

For now it’s a wait and see when they can book me in for the procedure. I don’t mind being hospitalised as I have been in hospital so many times since diagnosed with Stage 4 Classic Hodgkin’s Lymphoma, it’s the waiting I hate as it can play havoc on my mental health. But over the next week or so I can get ready to boost my body for surgery.

We also decided after my birthday to sell our house, I had the house valued on my birthday. This house as purchased in Feb 2024 and since then the house has been extensively renovated, thankfully nearly 100% of the work was completed by me and that meant a massive saving in contractor costs. The auctioneer was very impressed with the house and his valuation was roughly 15% greater than what I expected. We have two reasons to sell, the first is Anita’s current medical issues with her hip, the house is a two storey detached building with all bedrooms upstairs, I don’t want to start changing the downstairs front sitting room into a bedroom as it would mean redesigning the entire ground floor for easy access to the bathroom, the idea of installing a stair lift was explored, but we had one in my mum’s house and they can be iffy. The second reason is to help with our own finance, the past year has really hurt savings for medical procedures. Even today cost €250 plus travel to see the consultant, that means that since January 2025 I have had to pay out over €3,000 medically, our rough estimate since June 2024 would exceed €7,000, its not about the cost of living but the cost of staying alive. I suspect that we will stay locally in Galway as we like up here, the next will be a bungalow and hopefully our last house. Weeks of packing up will commence and I have already located a good storage unit 20 minutes from the house. Our auctioneer feels that the house will sell within 6 weeks from hitting the market and we will also start looking for temporary accommodation in Galway.    

Now its back to a waiting game as always. The fact that the urologist has red flagged this PCNL means that it will be prioritized

But in reality its down to getting a bed admission within the consultants ward. The PCNL is a serious operation and during my recovery the Hematologist will need to be available.

Following the PCNL I will have a CT Scan which will be most likely a CT NTAP contrast scan and this will highlight any issues with my lymph nodes.

Past experience has taught me to be ready to move fast when I get the call, on some occasions in the past this could be a call at 5pm with an admission that evening.

Life goes on hold for these appointments as they rarely give much notice.

I received a detailed guide to the operation on Monday 30^th of June which fully explained the procedure and the guidelines to follow after the operation.