Author Archives: Dr. Li

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About Dr. Li

I am a professional surgeon based in Beijing, China.

How is bile-duct stone disease treated?

The biliary tree is divided into intrahepatic and extrahepatic systems.
Extrahepatic bile ducts: gallbladder, common bile duct (CBD), common hepatic duct.
Intrahepatic bile ducts: second-order and third-order segmental ducts.
Treatment is chosen according to the exact location of the stone(s):

  1. Gallbladder stones – laparoscopic cholecystectomy.
  2. Common-bile-duct stones – laparoscopic CBD exploration with stone extraction.
  3. Intrahepatic stones complicated by cholangitis – often cause lobar atrophy; treat with hepatic lobectomy to remove the diseased parenchyma and relieve associated strictures.
  4. Diffuse intrahepatic stones (“full-liver” stones) – stricture-plasty or Roux-en-Y hepatico-jejunostomy is performed when extensive stricturing precludes simple clearance.
Stone LocationDescriptionPrimary Treatment
GallbladderExtrahepatic; stones within the gallbladder lumenLaparoscopic cholecystectomy
Common bile duct (CBD)Extrahepatic; stones distal to the cystic duct take-offLaparoscopic CBD exploration + stone extraction
Intrahepatic + cholangitisSegmental ducts (2nd/3rd order) with infection and lobar atrophyHepatic lobectomy (removes diseased lobe and stricture)
Diffuse intrahepatic (“full-liver” stones)Multiple strictures & stones throughout intrahepatic ductsStricture-plasty or Roux-en-Y hepatico-jejunostomy

Related articles：

  1. What causes stone disease?
  2. How long does it usually take for a stone lodged in the urethra to come out?
  3. How long does it take for the stone fragments to pass after extracorporeal shock-wave lithotripsy (ESWL)?
  4. What Are the Symptoms of Bile Reflux Gastritis
  5. What are the symptoms of vas deferens stones?
  6. Where in the human body can stones (calculi) form?

Is the onset of kidney stones sudden?

The acute pain caused by kidney stones often occurs suddenly. This happens when a stone, moving along with the urine flow, suddenly blocks the outlet of the renal pelvis or the ureter, causing urine to accumulate in the kidney and resulting in hydronephrosis. At this point, there is a sharp increase in pressure inside the renal pelvis, which can produce intense pain. This pain usually has no obvious warning signs and, once it appears, progressively worsens in a paroxysmal manner.

Patients need to go to the hospital immediately for symptomatic treatment, such as intramuscular injection of analgesics, extracorporeal shock-wave lithotripsy, or inpatient surgery. With the above treatments, renal colic caused by most kidney stones can be effectively relieved. For smaller stones, extracorporeal shock-wave lithotripsy combined with medication to facilitate stone passage can lead to complete expulsion and cure. However, for patients with larger stones, after pain and any infection are controlled, inpatient surgery is recommended to remove the stones and prevent future episodes of severe pain or infection.

AspectDetails
Onset of PainSudden; no obvious warning signs.
MechanismStone moves with urine → blocks renal-pelvis outlet or ureter → urine accumulates (hydronephrosis) → rapid rise in intrarenal pressure → intense pain.
Pain CharacterParoxysmal, progressively worsening.
Immediate ManagementSeek hospital care at once.
Acute Treatments1. I.M. analgesics
2. Extracorporeal shock-wave lithotripsy (ESWL)
3. In-patient surgery (if indicated)
Outcome for Small StonesESWL + medical expulsion → stone passage & cure.
Outcome for Large StonesPain/infection controlled → elective in-patient surgery to clear stones and prevent recurrence.

Related articles：

  1. Should patients with kidney stones take calcium supplements?
  2. Can patients with stones eat tofu?
  3. Can patients with stones eat yogurt?
  4. Where in the human body can stones (calculi) form?
  5. Is it a myth that pumpkin vines can cure stones?
  6. Can drinking too much tea cause stones?

What are the symptoms of vas deferens stones?

Vas deferens stones are relatively rare in clinical practice and occur mostly in young and middle-aged men. They are often caused by a deficiency of proteolytic enzymes in the seminal fluid. Some patients are asymptomatic, while others may experience hemospermia, painful ejaculation, or urinary discomfort. Diagnosis typically requires imaging techniques such as multislice spiral CT or ultrasound.

Because the stones are located within the vas deferens and generally do not move, many patients do not experience noticeable symptoms. However, if the stone is large or has sharp edges, it may damage the mucosal lining of the vas deferens, leading to bleeding and hemospermia during ejaculation. Due to their hard texture or irregular surface, the stones may shift during ejaculation, irritating surrounding mucosal nerves and causing varying degrees of ejaculatory pain. Some patients may also experience urinary discomfort.

Treatment of vas deferens stones may require surgery. Under combined or general anesthesia, patients are usually placed in the lithotomy position for stone removal. Alternatively, holmium laser lithotripsy can be used to fragment and flush out the stones. If the stones are small, they may be extracted directly using stone forceps or a stone retrieval basket.

SectionKey Points
EpidemiologyRare; predominantly young & middle-aged males
EtiologyDeficiency of proteolytic enzymes in seminal fluid
Symptoms• Often asymptomatic
• Hemospermia
• Painful ejaculation
• Urinary discomfort
Pathophysiology• Stones usually static → no symptoms
• Large/sharp stones → mucosal injury → hemospermia
• Hard/irregular stones may shift during ejaculation → nerve irritation → ejaculatory pain
DiagnosisMultislice spiral CT (non-contrast) or ultrasound
Treatment• Surgical removal (lithotomy position; combined/general anesthesia)
• Holmium laser lithotripsy (fragment & flush)
• Small stones: extraction with stone forceps / retrieval basket

Related articles：

  1. Is the onset of kidney stones sudden?
  2. Can patients with stones eat tofu?
  3. Can patients with stones eat eggs?
  4. Where in the human body can stones (calculi) form?
  5. Is it a myth that pumpkin vines can cure stones?
  6. Can drinking too much tea cause stones?

Which is better: endoscopic or conventional (open) thyroid surgery?

1. Size first: 4 cm is the cut-off

  • Benign nodules or papillary cancers ≤4 cm, intact capsule, no airway/nerve/vessel invasion
    → An endoscopic approach (trans-oral TOETVA, axillary, areolar, etc.) gives the same quality of lobectomy plus central-compartment dissection; six-month recurrence rates are identical to open surgery.
  • Tumours >4 cm, multifocal lesions kissing the recurrent laryngeal nerve, gross extrathyroidal extension or bulky lateral-neck nodes
    → Open operation gives a wider view, safer handling and a lower chance of “leaving disease behind”.

2. Patient second: can you tolerate CO₂ insufflation and a sub-cutaneous tunnel?

Green light

  • Age 18–60, BMI <30, no significant cardiopulmonary disease
  • No prior neck irradiation, no mandibular or oral cavity deformity
    → Cosmetic benefit delivered: 3–4 day stay, no visible neck scar.

Red light

  • COPD, coronary disease, obesity (risk of hypercarbia under CO₂ pneumo-space)
  • Chest-wall deformity, adolescents (difficult working space)
    → Open surgery is safer and faster.

3. Hospital third: is the gear—and the team—there?

  • Endoscopic: needs dedicated instruments, CO₂ insufflator, and a 30–50-case learning curve; total cost ≈ 8–12k RMB higher.
  • Open: available in every grade-A hospital, widest insurance coverage.

One-sentence decision table

≤4 cm, low-risk, high cosmetic demand, fit patient, experienced team→ Go endoscopic
>4 cm, high-risk, bulky nodes, obese/cardiopulmonary compromise→ Go open

Whichever route you take, book a serum thyroid function + neck ultrasound at one month and keep up with calcium/L-T₄ exactly as prescribed—that last step locks in long-term quality of life.

Related articles：

  1. How is extracorporeal shock wave lithotripsy (ESWL)?
  2. Is the onset of kidney stones sudden?
  3. Where in the human body can stones (calculi) form?
  4. How long does it take for the stone fragments to pass after extracorporeal shock-wave lithotripsy (ESWL)?
  5. What causes stone disease?
  6. What Are the Symptoms of Intestinal Fistula?