ureter stent and diving

[Soggy]

Some history before I get to my question:

I am 25 years old.

I had a congenital UJP obstruction of my left kidney removed when I was 8 years old. This left that kidney permanently enlarged, with some permanent hydronefrosis, but a nuclear renal scan showed it to be function above normal.

Fast forward to 3 years ago...I was diagnosed with having several large kidney stones (calculi) in the lower pole of my left kidney. They formed due to the hydronefrosis and enlargement of that kidney...basically there is static fluid and more pockets for stones to form. I had 4 Electro-shockwave Lithotripsies performed (ESWL) with a ureter stent in place for two of them. The stent was in for 6 weeks and caused a fair amount of discomfort during heavy physical activity. Even with the stent, I was regularly attending karate workouts, but was not participating in sparring classes. Since the stent is an open tube, I was given Detrol, a bladder-pressure lowering medication, to limit the amount of fluid reflux back into the kidney.

Much of the stones were passed, but since they were in the lower pole, a bunch also remained.

Fast forward to the present.

The remaining stone particles have reformed into four large stones which are now spread throughout the kidney. I am scheduled for at least one more ESWL which I will likely have a stent in place for. If I can talk the doctor out of it, I would like to avoid having the stent placed, but my question is:

Can I do mild diving with that stent in place? It looks like the ESWL will be schedule smack in the middle of the best diving of the year and I'd like to not miss out. I have a feeling the answer will be, "don't do it," but would like some medical opinions.

Thanks...

 

[Dr Deco]

Dear Aaron:

Stent and DCS

I would not see any increased risk of decompression sickness with this stent. My comments are limited to this aspect of diving.

Other Medical Effects

Additional risks are a different matter. Perhaps the physicians will comment in this particular situation.

Dr Deco :doctor:

 

[Doppler]

Hi Aaron:

I have lived with the discomfort of kidney stones since I was about the same age as you... I'm a lot older now -- mostly small enough to pass but a few have hung around for a while.

Had a stent in place during diving activities in Northern Lake Superior and executed several trimix dives (multiple deco gases) without increased discomfort, internal damage, or decompression complications... My urologist -- coincidently a diver -- gave me several "dos and don'ts." Suggest strongly you either contact a specialist with some experience diving or call DAN and talk to someone there... of course, not trying to tread on DR DECO's toes!!!!


DD

 

[Soggy]

bump....

I probably should've posted this to Diving Medicine rather than Dr. Deco.... whoops.

 

[Saturation]

Let me see if I can help Dr. Deco out.

There are few reports on urinary stents and diving.

In theory, there are no known mechanisms that could interfere with diving since the stent simply opens segments of ureter that is obstructed, stenosed, or defective. There is potential for reflux of urine back before the stent, but that should be of little concern, as urine is sterile with a potential for contamination only past the bladder into the urethra or if a signifant amount pools in the bladder for sometime.

A secondary concern is the potential for an infection or stone related kidney pain that has few treatment options when in remote diving locations, like mid-ocean liveaboards, something to consider only when the time comes. The tendency to form stones is likely associated with or another, congential issue.

For diving in many regional areas: Mexico and Caribbean, most areas are within a short flight for medical emergencies.

Make sure you have DAN insurance, bring some antibiotics in your med kit, drink plenty of fluids to flush the urinary system and enjoy your dives.

Keep us posted with your experiences, with so little information on stents it may pay to collate experiences into a publishable paper.

AaronBBrown once bubbled...
Some history before I get to my question:

I am 25 years old.

I had a congenital UJP obstruction of my left kidney removed when I was 8 years old. This left that kidney permanently enlarged, with some permanent hydronefrosis, but a nuclear renal scan showed it to be function above normal.

Fast forward to 3 years ago...I was diagnosed with having several large kidney stones (calculi) in the lower pole of my left kidney. They formed due to the hydronefrosis and enlargement of that kidney...basically there is static fluid and more pockets for stones to form. I had 4 Electro-shockwave Lithotripsies performed (ESWL) with a ureter stent in place for two of them. The stent was in for 6 weeks and caused a fair amount of discomfort during heavy physical activity. Even with the stent, I was regularly attending karate workouts, but was not participating in sparring classes. Since the stent is an open tube, I was given Detrol, a bladder-pressure lowering medication, to limit the amount of fluid reflux back into the kidney.

Much of the stones were passed, but since they were in the lower pole, a bunch also remained.

Fast forward to the present.

The remaining stone particles have reformed into four large stones which are now spread throughout the kidney. I am scheduled for at least one more ESWL which I will likely have a stent in place for. If I can talk the doctor out of it, I would like to avoid having the stent placed, but my question is:

Can I do mild diving with that stent in place? It looks like the ESWL will be schedule smack in the middle of the best diving of the year and I'd like to not miss out. I have a feeling the answer will be, "don't do it," but would like some medical opinions.

Thanks...

 

[Soggy]

Thanks for the advice!

One of my concerns was definately painful reflux. In the past, I was on Detrol because I had a fair amount of pain when urinating due to reflux back into the kidney. I am wondering if somehow external water pressure would influence that.

As for being in remote locations....that shouldn't be an issue. During that time I won't be traveling much...my diving will be mostly in New England with perhaps a few low-key SC dives thrown in.

 

[Saturation]

The likelihood of reflux back into the kidneys with diving is about the same as on the surface, again, in theory. Pressure at depth acts equally throughout the body except in air filled cavities like the lungs and ears, so the pressure differential between the stent would be similar as in the surface.

 

[md4p]

A few comments about stones and stents:

In addition to stagnant urine flow, another major risk factor for stone formation is low urine volume, and thus high concentration of the various stone-forming solutes in the urine. No matter what the underlying disorder, dehydration will increase risk of stone formation. So, although we have been taught to keep well hydrated to decrease risk of DCS, it is even more important to keep very well hydrated to decrease stone risk, especially while away on a dive trip.

The stent in place to allow stone/fragment passage will allow some urine to reflux, but short term sterile reflux is probably not harmful. Since urine is not compressible, pressure at depth should have no effect on bladder pressures. However, urine flow rates tend to increase at depth, (likely mediated through atrial natriuretic peptide and a response we exploit to aid diuresis in nephrotic syndrome), so the bladder may become more distended and thus increase reflux. You may need to be willing to empty it frequently (with or without regard to wetsuit effect) to reduce this risk. Detrol may indeed decrease bladder pressure, but may also allow for overdistention - again, the need for frequent emptying.

You know there are 2 kinds of divers: those who pee in their wetsuits, and those who lie about it. You may choose to be one or the other, but remember, an empty bladder is a happy bladder.

 

[Soggy]

md4p once bubbled...
You know there are 2 kinds of divers: those who pee in their wetsuits, and those who lie about it.

Peeing in the wetsuit isn't a problem...peeing in the drysuit is

 

[BIGJC]

Oh man that must hurt... I feel for you! I hope it all works out.

It is hard to find a doctor who is knowledgable about diving (especially technical diving) I live near Duke and have participated in several DAN studies and I can tell you that their knowledge on the subject is limited and for the most part dated as well... I know they have a different focus but I wish we could get together a reliable list of doctors who know what they're doing and publish it!

:cluck: