Navigating Kidney Stone Treatment: Delays and Concerns in Urology Care

Q: Navigating Kidney Stone Treatment: Delays and Concerns in Urology Care

Hello： The hospital's examination process follows a protocol and does not change based on individuals or specific conditions. <br>If you are unwilling to wait, you may consider switching to another hospital to see if you can get an appointment sooner. <br>As for ultrasound, it is

Regarding the ultrasound finding of a 1.2 cm kidney stone at the clinic, I was referred to a large hospital for lithotripsy, but the hospital has a long wait for the examination?

I have been suffering from recurrent urinary tract infections for over a decade, with more than 20 episodes.
Earlier this year, I went to a large hospital for ultrasound and X-rays, but no kidney stones were detected.
Finally, at a private internal medicine clinic, a clear 1.2 cm stone was found in my right kidney.
Since my right kidney is smaller, I was advised to go to a large hospital for lithotripsy, and I was referred there.
However, when I presented the referral and the ultrasound images from the clinic at the large hospital, the doctor immediately said, "Oh, you had an ultrasound here this year, but no stones were detected?" I replied, "The hospital's ultrasound is not performed by the same doctor; there is a significant difference.
The hospital's ultrasound is just a quick scan, while the clinic's doctor examined the kidney very carefully, which was quite painful." The doctor quietly remarked, "Actually, their technique is not very good," referring to the personnel at the large hospital.
As a result, they scheduled another ultrasound (why schedule it again if they couldn't detect it before?).
The ultrasound is set for August 27, and I won't return for a follow-up until September 8 to review the images.

I would like to ask if this delay is due to procedural reasons or if it is just this particular doctor's approach.
Given that I have already provided clear ultrasound images of the kidney stone, is there a faster way to proceed with lithotripsy? Additionally, if I delay further, is there a possibility that the kidney stone could move and cause severe pain? I really do not want to experience that kind of discomfort.
Thank you for reading this.

Qiao Qiao, 20~29 year old female. Ask Date: 2020/07/31

Dr. Du Shixi reply Urology

Hello: The hospital's examination process follows a protocol and does not change based on individuals or specific conditions.
If you are unwilling to wait, you may consider switching to another hospital to see if you can get an appointment sooner.
As for ultrasound, it is a necessary preliminary examination tool.
The National Health Insurance requires certain essential tests for lithotripsy.
If you choose not to undergo it, you will need to have a pyelography, which involves the use of a contrast agent.
Doctors generally prefer to schedule ultrasounds more frequently.
Regarding whether the stones will pass on their own, it is difficult to say.
However, you should understand that after lithotripsy, you still need to pass the fragments yourself, and there is a high likelihood of experiencing pain symptoms.
Currently, the best advice is to drink plenty of water and seek medical attention if symptoms arise.
If you are unwilling to wait, consider switching to another hospital.
Wishing you good health.

Reply Date: 2020/07/31

More Info

Navigating kidney stone treatment can be a frustrating experience, especially when faced with delays and concerns about the potential impact on your health. Your situation highlights several important aspects of kidney stone management, particularly in the context of recurrent urinary tract infections and the challenges of diagnostic imaging.

Firstly, it’s essential to understand that kidney stones can vary significantly in size and location, and their management often depends on these factors. In your case, a 1.2 cm stone in the right kidney is substantial enough to warrant intervention, especially given your history of recurrent urinary tract infections. The fact that you have experienced multiple episodes of inflammation over the years suggests that your urinary tract may be more susceptible to complications, including obstruction from stones.

The delay in scheduling your treatment, particularly the shock of being told that your previous imaging did not reveal the stone, can understandably cause anxiety. It’s not uncommon for different imaging techniques or operators to yield varying results. Ultrasound, X-rays, and CT scans can all provide different views of the urinary tract, and the skill of the technician can indeed influence the outcome. The fact that a smaller clinic was able to identify the stone while a larger hospital could not may reflect differences in the thoroughness of the examination rather than the quality of the equipment itself.

Regarding your concerns about the waiting period before treatment, it’s important to note that while waiting for a procedure can be concerning, the risk of significant harm to the kidney from a stone that is not causing acute obstruction is generally low. However, if the stone were to cause a blockage, it could lead to hydronephrosis (swelling of the kidney due to urine buildup), which can impact kidney function over time. Therefore, it is crucial to monitor your symptoms closely during this waiting period. If you experience severe pain, fever, or changes in urination, you should seek immediate medical attention.

In terms of expediting your treatment, it may be beneficial to communicate directly with your healthcare provider about your concerns. Expressing the urgency of your situation and the potential for complications might prompt them to prioritize your case. Additionally, inquire if there are any options for earlier imaging or if there are alternative methods for stone removal that could be considered, such as ureteroscopy, which may be performed sooner than shock wave lithotripsy (SWL).

As for your concern about the stone potentially moving and causing acute pain, it is indeed possible for kidney stones to shift within the urinary tract. If a stone moves into a position that obstructs the ureter, it can lead to severe pain, often described as renal colic. Staying well-hydrated is crucial, as increased fluid intake can help facilitate the passage of smaller stones and may reduce the risk of obstruction.

In summary, while the waiting period for your treatment can be anxiety-inducing, maintaining open communication with your healthcare team and monitoring your symptoms closely are key steps. If you feel that your concerns are not being adequately addressed, seeking a second opinion or discussing your case with a urologist who specializes in stone disease may provide additional insights and options for your care. Remember, proactive management of your kidney stones and urinary tract health is essential, especially given your history of recurrent infections.

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