Conversation: The conversation between human and AI assistant.
[|Human|] Hello Doctor, my daughter is serverly disabled and had a urethrenoscopy procedure on the 2nd may they removed a large stone from her renal pelvis but left 2 still in her kidney as it was too risky to remove them, she is not a good candidate for a PNCL so there isnt anything else they can do. The problem is everytime she urinates she is in excruciating pain where her body literally contorts and its causing her seizures to increase, she is on a constant high dose of morphine to no avail and now her palliative care doctor is prescribing ketamine and gabapentin. But I want some answers as to why she is in so much pain and not just masking over it with more drugs as she wasnt like this before the procedure ? Many thanks
[|AI|]  Hi thanks for your question. Your daughter is having kidney stone and biggest one removed through ureteroscope. The increase in pain after procedure could be due to small pieces of stones which broke from main big stone while removing or big stone is crushed to make it into small pieces so that it can be easily removed. These small left over pieces of stone try to pass out with urine and cause sever colicky pain. Colicky pain is always very sever, and it is due to obstruction of hollow viscus. She might be getting sever colicky pain when these small pieces of stone pass through with urine. The treatment she is receiving is right. She has to be on higher doses of strong painkiller like morphine or ketamine. Once all leftover pieces of stone pass away with urine she will have relief from pain. Advise her to take plenty of water.Re-consultation with urologist is advisable. Hope this answers your question.