Managing Kidney Stones: What to Do When Treatment Options Are Unclear

Q: Managing Kidney Stones: What to Do When Treatment Options Are Unclear

Hello： For a stone measuring 0.5 cm, it is generally recommended to observe, take medication, and drink plenty of water, as most will pass naturally. <br>Only a CT scan can detect these small stones. <br>It is advisable to drink water in moderation to avoid excessive fullness, an

Urinary tract stones, currently unsure how to proceed with treatment?

Hello Dr.
Du, last Thursday I experienced severe pain in my lower right abdomen and went to the emergency room.
The pain came in waves, gradually increasing in intensity, then subsiding, with each episode lasting about 10 minutes followed by a normal period of about half an hour.
After three cycles of pain, the emergency physician ordered blood tests, a urinalysis, and an X-ray, all of which did not reveal any issues.
Later, a CT scan with contrast was arranged, which showed a 5mm stone lodged in my right ureter.
However, by the time I reviewed the CT report, I was no longer in pain.
The emergency doctor mentioned that there was a chance the stone could pass naturally if I drank plenty of water.

In addition to the stone, it was noted that my white blood cell count was elevated (over 10,000, while normal is around 5,000), indicating an inflammatory response in my body, though I was unsure where the inflammation was located.
The doctor prescribed medication and instructed me to follow up with a urologist two days later (on Saturday).
After leaving the emergency room until Saturday, I drank over 3000cc of water daily, and I did not experience any abdominal pain (the original pain location was no longer painful), but I felt very full from drinking so much water (my abdomen was not hard, and I had normal urination, so I did not worry).
On Saturday, I visited the urologist, who requested a urinalysis.
That day, the doctor informed me that blood was detected in my urine, indicating that the stone had not yet passed.
The doctor continued to prescribe medication and advised me to drink more water.
On Monday, I had an X-ray, and when I returned to see the same urologist, the doctor told me that the X-ray did not show whether the stone had passed.
What?! What should I do now? I had an X-ray last Thursday that showed the stone, and now on Monday, another X-ray still could not determine if the stone had passed.
I asked the doctor what to do next, and he inquired if I was still in pain.
Since I was no longer in pain, he prescribed three more days of medication, advising me to take it only if I experienced pain during that time.
He instructed me to return for a follow-up in three months if I remained pain-free.
I then asked the doctor if there were stones in my kidneys as well, and he reviewed my CT report, confirming that there were stones in both kidneys.
He advised me to drink more water but did not provide any treatment plan for the kidney stones.
I am also unsure if my kidneys are inflamed or if there are other issues, such as edema.
I mentioned to the doctor that I felt soreness in both sides of my lower back, and he prescribed medication for rheumatoid arthritis, then sent me home.
Currently, I am mostly pain-free, but I am hesitant to take the medication prescribed by this doctor.
I am uncertain if I should continue to follow up on my urinary stones since it is unclear whether the stone has passed.
If left untreated, could there be serious complications (such as the stone growing larger, adhering to the ureter, or causing inflammation)? Should I seek care at another hospital? Or should I take the emergency CT report to another doctor for a second opinion? How should I proceed with treatment from another physician? I feel that my current urologist's approach is that if I am not in pain, no treatment is necessary.
Should the kidney stones also be left untreated? I am somewhat at a loss about what to do next.
I hope you can provide me with some advice.
Thank you.

POLLIN, 30~39 year old female. Ask Date: 2020/07/28

Dr. Du Shixi reply Urology

Hello: For a stone measuring 0.5 cm, it is generally recommended to observe, take medication, and drink plenty of water, as most will pass naturally.
Only a CT scan can detect these small stones.
It is advisable to drink water in moderation to avoid excessive fullness, and to drink in smaller amounts.
A white blood cell count of 10,000 may increase during certain discomforts and is not too serious; if there is no fever, follow-up blood tests can be done.
As for kidney stones that have not passed, no immediate treatment is necessary; increasing water intake can prevent them from growing (limit sugary drinks).
If there is kidney inflammation, fever may occur.
If you go to another hospital, there is no need for additional imaging; the images can be uploaded, and as long as the physician uses your health insurance card, they should be able to access them.
Just inform them that you have kidney stones and a right ureteral stone, and that you have undergone those tests at another hospital.
The physician will understand and follow up accordingly.
Personally, I believe that small stones that are not painful can be allowed to pass naturally, which is preferable to endoscopic surgery due to the discomfort and complications associated with anesthesia and invasiveness.
For kidney stones larger than 0.5 cm, extracorporeal shock wave lithotripsy may be considered, but it is better to address the right ureteral stone first before proceeding.
Wishing you good health.

Reply Date: 2020/07/28

More Info

Managing kidney stones can be a complex process, especially when treatment options are unclear. Based on your description, it seems you have experienced significant pain due to a 5mm stone lodged in your right ureter, which was identified through a CT scan after an episode of acute pain. The fact that you are currently asymptomatic is a positive sign, but there are several considerations to keep in mind regarding your ongoing management and follow-up.

Firstly, it is important to understand that kidney stones can vary in size and location, and their management often depends on these factors. A 5mm stone has a reasonable chance of passing naturally, especially with increased hydration, as you have been advised to drink over 3000cc of water daily. This is crucial because adequate hydration can help flush out the urinary system and facilitate the passage of smaller stones.

However, the presence of elevated white blood cell counts indicates a potential inflammatory response, which could suggest an underlying infection or irritation in the urinary tract. This is concerning, as untreated infections can lead to more severe complications, including pyelonephritis (a kidney infection) or sepsis. Therefore, it is essential to monitor for any signs of infection, such as fever, chills, or worsening pain.

Regarding your follow-up with the urologist, it is understandable to feel uncertain, especially since the X-ray did not provide clarity on whether the stone has passed. If you continue to experience symptoms or if you develop new symptoms, it is crucial to return to your urologist or seek a second opinion. You have the right to ask for further imaging studies, such as a repeat CT scan or ultrasound, to assess the status of both the ureteral stone and any renal stones.

If you are concerned about the management approach of your current urologist, seeking a second opinion from another specialist is a reasonable course of action. You can bring your previous imaging results and medical history to the new consultation, which will help the new physician understand your case better. It is also advisable to inquire about the management of the stones in your kidneys, as they may require different treatment strategies depending on their size and composition.

In terms of preventive measures, maintaining hydration is key, but you should also consider dietary modifications. Reducing intake of foods high in oxalates (such as spinach, nuts, and chocolate) and increasing the consumption of citrus fruits, which are high in citric acid, may help prevent the formation of new stones. Additionally, discussing the potential use of medications that can help prevent stone formation with your healthcare provider may be beneficial.

In summary, while you are currently asymptomatic, it is essential to remain vigilant about your condition. Continue to monitor your symptoms, maintain hydration, and follow up with your urologist or seek a second opinion if you feel your concerns are not being adequately addressed. Your health and peace of mind are paramount, and you deserve a treatment plan that is thorough and responsive to your needs.

Similar Q&A

Understanding Ureteral Issues: Managing Kidney Stones and Narrowing

Hello doctor, last Friday I suddenly experienced severe pain in my lower left abdomen. I went to the emergency room and was diagnosed with kidney stones. After that, I consulted a doctor who performed a ureteroscopy and mentioned that my ureter is too narrow, and even the smalles...

Dr. Lin Wenxu reply Urology
Regarding the treatment options for ureteral stones: 1. For small stones (<0.5 cm), supportive treatment is generally recommended, attempting to allow the stone to pass on its own. 2. For larger stones (>0.5 cm) or in cases of intolerable renal colic or associated infection...

Managing Kidney Issues in Elderly Patients: Treatment Options and Considerations

Consulting a physician: My father is 80 years old and regularly takes medication for hypertension, diabetes, and gout. Recently, due to urine test results indicating an infection, a kidney ultrasound was performed, revealing deteriorating kidney function and a 0.6 cm stone on the...

Dr. Yang Jun reply Internal Medicine
Hello, in response to your inquiry: Your father is 80 years old and has a history of hypertension, diabetes, and gout. The urinalysis shows signs of infection, which may be caused by prostatitis or benign prostatic hyperplasia leading to urinary difficulties, and it is not necess...

Understanding Prostate Issues and Kidney Stones: Treatment and Management

Hello, Dr. Hsu. About 7 to 8 years ago, I had a urinary stone episode that woke me up in the middle of the night due to pain. The doctor treated me with medication for the stones, and I haven't had that issue since. However, a few years later, I developed benign prostatic hy...

Dr. Xu Weikai reply Urology
1. The prostate gland tends to enlarge with age, and symptoms may become increasingly severe. Generally, there are two treatment options: medication and surgical intervention. Both are quite effective. Note: Medication requires lifelong adherence, while surgery may have a possibi...

Managing Ureteral Stones and Hydronephrosis: Treatment Options Explained

Hello, doctor. I previously inquired about ureteral stones and underwent endoscopic surgery at a medical center, but the surgery was unsuccessful in removing the stones. The doctor mentioned that the stones might have been lodged for too long, causing the ureter to narrow, which ...

Dr. Du Shixi reply Urology
Hello: The X-ray dosage is generally acceptable, as current hospital equipment is very attentive to dosage (the government is also regulating it). The radiation should not be too high. However, in your case, the flexible ureteroscope may not be able to pass, so you may still need...