Urological Issues: Kidney Stones and Prostate Enlargement Symptoms

Urological issues

Hello Doctor, in February, a kidney stone fell and got stuck at the end of the ureter.
An ultrasound showed three stones measuring 0.6 to 1 cm in each kidney.
At the one-month follow-up, the stones were no longer visible, and I don't recall feeling any urine output.
In March, I experienced frequent urination and sought medical attention.
It was noted that I had mild benign prostatic hyperplasia, with symptoms of frequent urination, bladder tightness, and a feeling of urgency to defecate.
There was also tenderness upon palpation of the testicles.
A rectal ultrasound was normal, PSA was 0.68, urinalysis was normal, and X-rays showed no stones in the bladder or ureters.
I was prescribed Urinary Tract Antiseptic.
In April, I developed herpes zoster on my face, which has since healed.
I have been taking Urinary Tract Antiseptic since March, and my symptoms have been fluctuating.
When the bladder feels tight, palpating around the bladder causes pain, and when the bladder relaxes, pressing on the area just below the pubic bone causes a sharp pain (I have experienced this sensation for the past six months).
Urination has improved, the feeling of urgency has resolved, and the testicular pain is gone, but I still feel a tightness in the bladder with the sensation of needing to urinate, although I don't feel an urgent need.
A peculiar phenomenon occurs frequently: when I feel uncomfortable, my limbs feel weak, my hand movements become imprecise, and I feel strange and uneasy, with a slight chill.
When the bladder feels better, those symptoms subside.
At the beginning of August, I had a follow-up appointment, and my PSA was 0.54.
The doctor advised me to continue the medication.

I would like to ask the doctor: 1.
Are the overall symptoms related to the kidney stones? Is it necessary to remove the kidney stones to prevent future issues? 2.
Could mild benign prostatic hyperplasia be responsible for these symptoms? Thank you for your response.

H Jun, 40~49 year old female. Ask Date: 2016/08/17

Dr. Xu Wencang reply Urology

Further examinations can be conducted to confirm whether there are stones in the distal ureter, which may also cause lower urinary tract symptoms and pain.
Next, we should rule out chronic prostatitis and interstitial cystitis, and initiate some pharmacological treatment.

Reply Date: 2016/08/17

More Info

Understanding urological issues, particularly those related to kidney stones and prostate enlargement, can be quite complex. Your symptoms and medical history suggest a multifaceted situation that requires careful consideration.

Kidney Stones and Their Symptoms
Kidney stones can cause a variety of symptoms, including severe pain, hematuria (blood in urine), and urinary frequency. In your case, you mentioned that you had kidney stones that were previously diagnosed and then seemingly resolved, as indicated by the absence of stones on follow-up imaging. However, the fact that you experienced a sensation of stones being present and the discomfort in your bladder area suggests that there may still be residual effects from the stones or other underlying issues.

The sensation of having a full bladder, along with the urgency and discomfort, can sometimes be attributed to irritation of the bladder lining due to previous stone passage or inflammation. Even after stones have passed, the bladder can remain sensitive, leading to symptoms such as urgency and frequency.

Prostate Enlargement
Your diagnosis of mild prostate enlargement (benign prostatic hyperplasia, or BPH) can also contribute to urinary symptoms. BPH can lead to increased urinary frequency, urgency, and a sensation of incomplete bladder emptying. The prostate gland surrounds the urethra, and as it enlarges, it can compress the urethra, making it more difficult to urinate and leading to the symptoms you described.

The fact that you have experienced a reduction in some symptoms with medication (likely an alpha-blocker or similar) is a positive sign. These medications work by relaxing the muscles around the prostate and bladder neck, improving urine flow and reducing symptoms.

Connection Between Symptoms
1. Kidney Stones and Symptoms: Your symptoms may indeed be related to your history of kidney stones. Even if the stones are no longer present, the bladder can remain reactive or inflamed, causing discomfort and the sensation of urgency. It is also possible that small fragments of stones could still be present, which might not be visible on imaging but could cause irritation.

2. Prostate Enlargement: The mild enlargement of your prostate can certainly contribute to your urinary symptoms. The combination of BPH and any residual effects from kidney stones could explain the complexity of your symptoms.

Recommendations
1. Further Evaluation: Given your ongoing symptoms, it may be beneficial to undergo further evaluation. This could include a urodynamic study to assess bladder function and pressure, which can help determine if there are any underlying issues contributing to your symptoms. A cystoscopy might also be warranted to visually inspect the bladder for any abnormalities.

2. Management of Kidney Stones: If you have a history of recurrent stones, it may be advisable to consider preventive measures, including dietary modifications and increased fluid intake. If stones are found again, discussing options for removal, such as lithotripsy or ureteroscopy, may be necessary to prevent future complications.

3. Prostate Management: Continuing your current medication for BPH is important. Regular follow-ups with your urologist to monitor your prostate size and PSA levels will help ensure that any changes are promptly addressed.

4. Symptom Tracking: Keeping a detailed log of your symptoms, including when they occur and their severity, can provide valuable information to your healthcare provider. This can help tailor your treatment plan more effectively.

5. Lifestyle Modifications: In addition to medical treatment, lifestyle changes such as pelvic floor exercises, avoiding bladder irritants (like caffeine and alcohol), and maintaining a healthy weight can also help alleviate symptoms.

In summary, your symptoms are likely a combination of residual effects from kidney stones and mild prostate enlargement. Ongoing communication with your healthcare provider and a thorough evaluation will be key to managing your condition effectively.

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