Urinary Tract Stones: When to Seek Follow-Up Care

Urinary tract stones issue?

Hello, I previously went to the emergency room due to hematuria.
After an X-ray and urinalysis, the doctor diagnosed me with cystitis and prescribed a three-day course of antibiotics.
Three days later, I visited a urologist, who performed an ultrasound on my kidneys and bladder.
He mentioned that there are small kidney stones that do not require treatment, and that the hematuria could be due to either inflammation or the stones moving.
He then prescribed an additional seven days of antibiotics along with medication to help pass the stones.
My hematuria has improved significantly.

I would like to know if I need to return to the urologist for a urinalysis after finishing the medication to check for any remaining inflammation or hematuria.
The doctor mentioned that the stones may take a month to pass.
If there is still inflammation or hematuria, is that a concern? I am worried that if the bacteria are not completely eradicated, it could lead to antibiotic resistance.

1.
Do I need to return for a follow-up appointment, or can I skip it if I do not have any obvious symptoms (hematuria)? Thank you!
2.
Additionally, I discovered three years ago that I had stones, but they have not increased in size.
Should I return for a follow-up every time I experience hematuria, or can I wait until I have specific discomfort? Thank you!

Mr. Li, 20~29 year old female. Ask Date: 2015/06/22

Dr. Fu Shizhang reply Urology

If there are concerns about antibiotic resistance, it is recommended to visit an outpatient clinic for a urine test to confirm that the inflammation has been fully treated.
If kidney stones are small and asymptomatic, follow-up visits to the outpatient clinic every six months to a year are advised.
However, if symptoms such as hematuria or severe pain occur, it is essential to seek immediate medical attention at the outpatient clinic.

Reply Date: 2015/06/22

More Info

When dealing with urinary tract stones, it is crucial to understand the symptoms, follow-up care, and when to seek medical attention. Based on your situation, it appears that you have experienced blood in your urine (hematuria) and have been diagnosed with a urinary tract infection (UTI) and small kidney stones. Here’s a comprehensive overview of what you should consider moving forward.

Follow-Up Care After Treatment
1. Completion of Antibiotics: After completing your course of antibiotics, it is advisable to follow up with your urologist, especially since you initially presented with hematuria. While the blood in your urine has improved, it is essential to ensure that the infection has been fully resolved. A follow-up urinalysis can help determine if there are still signs of infection or any residual blood in your urine.

2. Monitoring Symptoms: If you experience any recurrence of symptoms such as hematuria, pain, or changes in urination, you should seek medical attention promptly. Even if you feel better, it’s important to monitor for any signs of complications, such as persistent pain or fever, which could indicate an ongoing infection or other issues.

3. Timeframe for Follow-Up: Since your doctor mentioned that the stones are "on the move," it is reasonable to expect that you may need to wait a month to see if the stones pass naturally. However, if you notice any worsening of symptoms or if new symptoms arise, do not hesitate to return to your urologist sooner.

Understanding Kidney Stones and Their Management
1. Stone Size and Composition: You mentioned that the stones are small and not requiring immediate intervention. Generally, stones smaller than 5 mm have a good chance of passing on their own. However, if you have a history of stones, it’s wise to keep an eye on their size and composition, as certain types of stones may require specific dietary adjustments or medications to prevent recurrence.

2. Preventive Measures: Since you have a history of kidney stones, consider discussing preventive strategies with your urologist. This may include dietary changes, increased fluid intake, and possibly medications to help prevent stone formation. Staying well-hydrated is crucial, as it can help dilute the substances in urine that lead to stone formation.

3. Follow-Up Based on History: Given that you have had stones for three years without significant growth, it may not be necessary to return for every instance of hematuria unless accompanied by pain or other concerning symptoms. However, if you notice any changes in your urinary habits or if the stones begin to cause discomfort, it would be prudent to seek evaluation.

Concerns About Antibiotic Resistance
Your concern about antibiotic resistance is valid. It’s essential to complete the prescribed course of antibiotics to ensure that the infection is fully treated. If you find that you frequently require antibiotics for UTIs or other infections, discuss this with your healthcare provider. They may consider performing urine cultures to identify the specific bacteria and determine the most effective antibiotic treatment.

Conclusion
In summary, after completing your antibiotics, it is advisable to have a follow-up appointment with your urologist to ensure that the infection has resolved and to monitor for any potential complications related to your kidney stones. Keep track of your symptoms, and do not hesitate to seek medical attention if you experience any new or worsening issues. Regular follow-ups and preventive measures can significantly reduce the risk of recurrent stones and infections, leading to better overall urinary tract health.

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