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Urology (Expert Forum)
pain in ureter, blood in urine, is it stones again?
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
pain in ureter, blood in urine, is it stones again?
by nts, Apr 14, 2004 12:00AM
Here's my history.
-37 yr old female, born 4 pds. prematurely, asthmatic, 35 pds. overweight.
-Ages 14-18, numerous bladder infections, ivp revealed nothing.
-Age 19 & 22, had the typical pain associated with stones, ventured to ER. Catscan done, no ivp. diagnosis: probably small stones.
-Age 25, Catscan showed nothing, IVP revealed two small stones. Repeated tests revealed passed them on own about 2 months later.
-Age 29, another bout. Decided to give up tea drinking. Seemed like the only thing that I induldged in on the recommended list.
-Age 37, After being symptom free for 7 years, doubled over in severe pain, CT revealed nothing, 2 days later, back in ER, IVP revealed no stones, but hydronephrosis. Small stone hung up on ureter removed, stent put in and removed two weeks later.
-Since this was done back in May, I kept getting jolts every now and again where I would feel like I was going to double over in pain, but didn't.
-I followed up with a urologist in Dec. He recommended I go for a renal ultrasound. I unfortunately put it off.
-1 week ago, got pain in my kidney for several hours, but it moved into my ureter. Wasn't that terrible unbearable pain, but I thought I should call the urologist anyway. He said, go for the ultrasound I recommend and call me after 24 hrs. for the results.
-That night pain got worst, I ended up in an er room nearby which this urologist is no longer affliated with. They did Catscan, showed nothing, but blood in urine was noted.
-I decided to follow up with a different urologist who would be affliated with my local hospital. He recommends what he called an ivp in reverse, dye from outside in, but I need to be sedated, which I absolutely hate.
-What would you say? Could it be a small stone or or could there does everyone keep thinking it is small stones and possible larger problem? Why has no one ever tested my stones? Am I giving these to myself by not drinking enough water? Am I crazy or are you to run to the bathroom 3 times, every 5 or so minutes after drinking one glass of water?
I am still experiencing on and off pain in my back right above the hip line, is this kidney area? I have forgotten. I can tell you the pain in the ureter is definately that..on the side from hip down on an angle. Could it be a gynological/pelvis problem or something? I did have cesearan section, miscarriage two yearsago. I am overdue by 8 months for a papsmear. I have also been getting wierd pain in my chest at night when I raise my hands above my head as I am sleeping. Not sure if related, but thought should note. From my notes, I realize I am not taking very good care of myself these days, but want to ask what tests should I have done?
-37 yr old female, born 4 pds. prematurely, asthmatic, 35 pds. overweight.
-Ages 14-18, numerous bladder infections, ivp revealed nothing.
-Age 19 & 22, had the typical pain associated with stones, ventured to ER. Catscan done, no ivp. diagnosis: probably small stones.
-Age 25, Catscan showed nothing, IVP revealed two small stones. Repeated tests revealed passed them on own about 2 months later.
-Age 29, another bout. Decided to give up tea drinking. Seemed like the only thing that I induldged in on the recommended list.
-Age 37, After being symptom free for 7 years, doubled over in severe pain, CT revealed nothing, 2 days later, back in ER, IVP revealed no stones, but hydronephrosis. Small stone hung up on ureter removed, stent put in and removed two weeks later.
-Since this was done back in May, I kept getting jolts every now and again where I would feel like I was going to double over in pain, but didn't.
-I followed up with a urologist in Dec. He recommended I go for a renal ultrasound. I unfortunately put it off.
-1 week ago, got pain in my kidney for several hours, but it moved into my ureter. Wasn't that terrible unbearable pain, but I thought I should call the urologist anyway. He said, go for the ultrasound I recommend and call me after 24 hrs. for the results.
-That night pain got worst, I ended up in an er room nearby which this urologist is no longer affliated with. They did Catscan, showed nothing, but blood in urine was noted.
-I decided to follow up with a different urologist who would be affliated with my local hospital. He recommends what he called an ivp in reverse, dye from outside in, but I need to be sedated, which I absolutely hate.
-What would you say? Could it be a small stone or or could there does everyone keep thinking it is small stones and possible larger problem? Why has no one ever tested my stones? Am I giving these to myself by not drinking enough water? Am I crazy or are you to run to the bathroom 3 times, every 5 or so minutes after drinking one glass of water?
I am still experiencing on and off pain in my back right above the hip line, is this kidney area? I have forgotten. I can tell you the pain in the ureter is definately that..on the side from hip down on an angle. Could it be a gynological/pelvis problem or something? I did have cesearan section, miscarriage two yearsago. I am overdue by 8 months for a papsmear. I have also been getting wierd pain in my chest at night when I raise my hands above my head as I am sleeping. Not sure if related, but thought should note. From my notes, I realize I am not taking very good care of myself these days, but want to ask what tests should I have done?
Doctor's Answer
by Kevin Pho, MD, Apr 14, 2004 12:00AM
, Apr 14, 2004 12:00AM
The CT scan is a pretty sensitive test for stones. Ensure it was a non-contrast helical CT - this is the appropriate test for kidney stones. The follow-up IVP test that has been suggested is a reasonable next option if the diagnosis is non-revealing thus far.
If there is evidence of stones, you may want to get it sent off to the lab to analyze the composition. Metabolic abnormalities can predispose you to further stones. Initial drug therapy varies with the metabolic abnormality that is present:
* Thiazide diuretics for hypercalciuria
* Potassium citrate or allopurinol for hyperuricosuria
* Potassium citrate for hypocitraturia
* Potassium citrate for type 1 renal tubular acidosis
If stones has been completely ruled out, you may want to inquire about a GYN disease - reasonable tests would include a pelvic CT scan or transvaginal US.
For the chest pain - I would first ensure you don't have any heart problems. A stress test can be considered.
You may want to discuss these options with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
Rose. Treatment of recurrent calcium stones. UptoDate, 2004.
If there is evidence of stones, you may want to get it sent off to the lab to analyze the composition. Metabolic abnormalities can predispose you to further stones. Initial drug therapy varies with the metabolic abnormality that is present:
* Thiazide diuretics for hypercalciuria
* Potassium citrate or allopurinol for hyperuricosuria
* Potassium citrate for hypocitraturia
* Potassium citrate for type 1 renal tubular acidosis
If stones has been completely ruled out, you may want to inquire about a GYN disease - reasonable tests would include a pelvic CT scan or transvaginal US.
For the chest pain - I would first ensure you don't have any heart problems. A stress test can be considered.
You may want to discuss these options with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
Rose. Treatment of recurrent calcium stones. UptoDate, 2004.
