Im Confussed

  I am a 23 yeard old female with so called recurrent hydronephrosis. I have been having pain in my right flank and also lower abdnomen for aprox. 2 months. Numerous er physicians diagnosed me with as many thing as you can think of. I had 4 types of antibiotic for 3 weeks and they never helped my pain or took away my low grade fever (99.6). My family physician after reading my IVP seemed very disinterested. I changed physicians and the new one ordered a CT scan. He called me back the next day and told me I had multible stones, that is the cause of all my pain. He directed me to a urologist. I had one of thoes cystogram cystoscopy deals. The urologist said I have a few small stones on the left side nothing to bother with, after 2 1/2 hours under the scope. I still feel flank pain and all my blood work comes out healthy, he said if i still have pain in 3 days he will recommend me to a general surgeon. Is there something he could be missing? After urination I have a lot of pain in my lower abdnomen like there is some type of blockage. And when the pain starts it is usually accompinied with fever. Please share your expertise. Thankyou
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Dear Mrs. Briceno,
Hydronephrosis is dilation of the urinary tract that is due to poor drainage of urine, usually due to some type of obstruction.  The source of obstruction can be due to a congenital problem such as congenital stricture of the ureteropelvic junction (the point where the ureter comes off the collecting portion of the kidney), or due to an acquired problem that obstructs urinary flow such as a kidney stone.  Hydronephrosis usually causes flank pain on the affected side and may be seen on an ultrasound, IVP, or CT scan.  When urinary drainage is poor, the stagnant urine can become infected and cause fevers associated with the flank pain.  In such a case, the most important treatment in addition to antibiotic therapy, is making sure the urine is draining and to somehow bypass the obstruction.  However, sometimes a person can develop pyelonephritis (infection of the kidney) without any hydronephrosis which is treated with antibiotics, and will not require any procedures to allow for urine drainage.
I am concerned because you indicate that you have hydronephrosis, stones, and fevers in addition to your flank pain.  Although I do not know the specifics about your individual case, such a combination can be potentially dangerous, because the hydronephrosis and flank pain indicates poor drainage for whatever cause (stones perhaps?) and fevers indicate that the urinary system may be infected, and you may develop pus behind the point of obstruction.  Now, you indicated that your cystoscopy (looking in the bladder) took 2 1/2 hours.  This procedure normally takes only a few minutes, and it is possible that your urologist placed a stent (that you may have forgotten to mention).  A stent is a thin plastic tube that extends from the kidney into the bladder and allows for obstructed urine or pus to drain.  Such a procedure would be appropriate and may sometimes take up to several hours if it is a difficult stent placement.  I encourage you to speak to your urologist to make sure you know exactly what he/she did, what they are thinking, and why they are considering a general surgery consultation.  Wish you the best.
This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).
Sincerely,
HFHS M.D.-JJ
*Keyword: pyelonephritis, pyonephrosis, hydronephrosis