Slow hematuria treatment

[SDV__0]

  My father first noticed blood in his urine on July 6.  Went to dr. for treatment and was told there was nothing wrong.  Week later started to feel side pain.  Went back to dr. who administered an IVP on July 24.  On July 25 was rushed to ER in severe pain, diagnosed finally with 2 infected kidney stones.  Given antibiotic and painkillers and told to drink water.  IVP results were negative for stones.  Still in pain and returned to ER on August 7, where 2 stones (3mm) finally showed up on a CT scan.  Again sent home to drink water.  Due to our impatience with the wait and see attitude of this dr, we switched to another.  Now we are waiting for a cystoscopy to be performed next week.  I'm wondering if anyone else thinks that treatment has been delayed too long in this case and can anyone tell me how much more pain my father will endure with the cystoscopy?  And does this sound like "just" kidney stones?  He's lost almost 15 pounds in the last month alone.  Shouldn't a cystoscopy have been performed already?
  Thanks.
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Dear SDV,
Hematuria is the medical term for your fathers condition.  It is important to have a microscopic cell count done to determine if this amount of hematuria needs to have a full work-up.  Above 3 RBC/HPF is suggestive of significant hematuria that needs work-up.  
A full work -up consists of a history and physical to direct the studies ,an IVP which has already been done not showing stones and I presume negative for any anatomic abnormalities, a cystoscopy which should be done by a urologist to rule out bladder cancer, and a cytology looking for cancerous cells in the urine.  A significant number of patients at our institution have some pathology causing their hematuria.  In this case you have documented stones on CT scan.
Considering the symptoms that your father has, I agree that a stone could account for the blood in the urine and the pain.  Some stones are made of uric acid and are not seen on IVP. This may explain why the stones were not initially diagnoses and the CT scan finally picked them up..
Another possible diagnosis would be bladder cancer.  Some times bladder cancer presents with blood in the urine and irritative symptoms similar to a stone.  This is why we perform cystoscopy, to rule out any suspicious lesions in the bladder.  The cystoscopy also allows the urologist to examine the anatomy of the bladder and position of the ureteral openings in the bladder.
The reason your doctor has probably given him pain medication and told him to drink fluids is he thinks the stones are going to pass on there own.  About 95% of stones less than 5mm that are in the distal ureter will pass on there own.  As long as your father is keeping down fluids and his pain medication, I don’t think there is any rush to take him to the operating room.  On the other hand, if this pain is crippling and your father cannot go about his daily activities, go to work, or do whatever he wants to do, he could have the stones taken out surgically through a ureteroscope (a telescope like instrument that can be inserted into the ureter where your father’s stones are located).  Your doctor is simply trying to save your father from the operation to remove the stones with a basket
In regards to the cystoscopy, this could be done at anytime following the stone passage if the blood in his urine persists. At this point in time we have a good reason for the bleeding, although it is possible to have a cancerous lesion concurrent with the stone, it is unlikely.
I think your urologist is giving you the correct information and is trying to help him pass these stones with the least amount of pain for your father.  If after a time the stones don’t pass on there own, surgical intervention will be necessary.
This information is provided for general medical educational 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.-AK
*keyword:Hematuria