Hello Sir,
I am assuming your a man because of the medication you are on. Your situation does indeed sound complicated. I'm having a hard time understanding why if you had kidney stones the doctors took out your gallbladder unless of course you had gallstones as well. Generally speaking when a patient comes in with unexplained upper abdominal pain we look at the gallbladder (on the right), check out the liver, pancreas and kidney. All can be examined with an abdominal ultrasound. The kidney is more in my special area and I do perform renal ultrasounds. I understand the abnormalities you mentioned and do see how they could make conditions favorable for stone formation. I don't understand why if you had ten stones in your ureter they weren't found early on. Generally we do and Intravenous Pyelogram (a contrast x-ray) that will out line the kidneys, bladder, and ureters. Even if the stones were uric acid in nature (these do not show up well on x-ray because they do not generally calcium deposits) the space the stones would occupy would leave a filling defect in the ureter indicating to the doctor that they were there. I would have thought this would have been found fairly quickly and would have been looked to as the source of your pain first. However, understand that there are things I don't necessarily know about your case. It is normal to leave a stint in for a period after removing stones and sometimes these are left in for indefinite periods of time. (Actually the have to be replaced periodically, like every six months or so.) Anyway, I'm not sure if yours is still in place or not. Some people do not tolerate stints very well and may have what is described as colic. This is obviously most likely ureteral colic, not renal, although I guess it could be argued that it could cause renal colic. I have heard of ditropan XL and detrol being used to reduce colic. These medicine act on smooth muscle tissue and cause it to relax basically. Some individuals simply cannot tolerate the stint no matter what we do and it has to be removed and the patient monitored for kidney stone formation and hydronephrosis (fluid backed up into the kidney). You may be one of these people. The other medicines proscar and cardura are dealing with your bladder neck. The proscar is designed to help shrink the prostate or retard it's growth and no one knows for sure how well it works. It takes a long time to get into the system and see any results. Cardura is a beta blocker that is also used for high blood pressure patients and has an effect on the tissue around the bladder neck. This is a good drug but we are tending to use flomax more now because it relaxes the bladder neck without the anti-hypertensive results. You said you had a cystogram, which is an x-ray where they fill the bladder with x-ray dye and take x-rays. I do not see how your doctor could quantify your bladder pressures based on this test. Although one could summize that you were having bladder contractions by watching the bladder expel the contrast around the catheter the pressures couldn't be quantified without some type of manometry. Generally when we are concerned about bladder pressure, especially in someone with a known neurological lesion and questionable bladder neck outlet obstruction it is necessary to do some type of urodynamic testing on the bladder. This could be a basic cystometrogram or CMG on up to sophisticated video urodynamics, which I also do and teach others to do around the country. As you can see there are a lot of unanswered questions here. I do not think I would be in a hurry to have the bladder neck resection, unless what they are prescribing is a transurethral resection of the prostate (if you have significant BPH(benigh prostatic hypertrophy) which is obstructing your bladderneck. If you had this surgery then you would likely see an increase in leakage because the prostate itself is more than likely helping to keep you dry for the same reason it is making your bladder pressures high - it's in the way. There is a new procedure that uses microwaves to shrink the prostate tissue called TARGIS and some other variations of the same type. The flip side of not having anything done is that if your bladder really is under very high pressure then this is putting a great deal of back pressure on your kidneys and eventually could erode the kidneys causing permanent damage and end you on dialysis. So ultimately you have to weigh your options and try to get a gut feeling about the urologist your seeing and how much you trust him/her. If you doubt your urologist at all please see another one. If you tell me what state and city you are in I might be able to get you a recommendation for a good urologist. As much as I hate to admit it they are not all great and some are not even good, trust your instincts. I'm sorry I do not have any specific internet sites to help you with your problem but if I can answer any further questions or clarify anything please let me know. Thanks