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Clarify questions re kidney stone treatment & UTIs

Dr. Liroff-- Thanks for your Nov 16 helpful reply. Have tried everything except CT Uro (if it is different from Abdominal CT, done Feb 08 (w/contrast) & Mar 09 (w/o contrast).  Both showed the stone. Also 2009 CT report or “oval low density lesion of near water attenuation in left adrenal gland, measuring 12 x 11 mm.  Lesion consistent with adrenal adenoma.”  Any connection?  Was told that was incidental finding – didn’t mean anything.  I just revisited the UroGyn and Urologist.  The UroGyn had same opinion as you about going after the stone (with basket).  He said it would be easy (mid-kidney calix)  Urologist said if a stone caused infection, it would not be E coli.  (Have had positive cultures for staph, strep, E hermanos, kleb pneumonia and citro koseri – mostly E coli past few months.)  Asked Urologist about CT urogram - he said it would reveal less than the abdomen/pelvic CT, but nothing was reported about .  Said going after stone would be a surgery, & he didn’t think that was a good idea.  Have stinging sensation in lower back above waist.  Have had big ache under front left ribcage, around side to back ribcage since 2007.  From UTIs and stone?  My questions:  1) Time to be seen for another opinion?  Too bad I am in Texas. 2) Is the adrenal lesion of no concern? 3) correct or incorrect about E coli not being the type of bacterial infection (in UTI) that would result from a stone? 4) Is it possible to have a kidney infection w/o a fever?  Always subnormal since 2007 & always cold.  At recent vascular screening technician ran the wand over left kidney from side. She pointed out stone and constellation of 8-10 smaller images.  Possible calcium deposits from Vit D def + low calcium from year ago? Endocrinologist suggested ck for parasites in bladder.  Asked if I had ever been in Bahamas (yes).  Any other ideas?  Leaky gut?

Again, my thanks, Dr. Liroff.  The protocol you outlined seems 100% logical to me.
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There is little additional information that a CT urogram would provide in your case. Not worth the additional radiation unless something has really changed in your symptoms or findings (on physical exam), in my opinion. Kidney stones can have any bacteria in them, including E.Coli, but the fact that your UTI’s  have not all been caused by the same bacteria is against the stone as a cause. Getting rid of the stone is indicated on the basis of its growth alone and as I indicated earlier, takes this “out of the picture” as a cause for anything. As regards surgery, few stones require open surgery today. Most can be either fragmented (with extracorporeal shock wave lithotripsy) or approached through a small incision in the back using a telescope like instrument and fragmenting the stone and then removing the stone particles (percutaneous nephrolithotomy) or threading a ureteroscope up into the kidney through your bladder under anesthesia.
As regards parasites, with culture proven clear urine specimens between infection, I think this doubtful.
Renal infections lasting any length of time without fever, quite doubtful. Subnormal temperatures do not fit into this picture.
Abdominal CT’s following a stone protocol are exquisitely sensitive to stones/calcium deposits in the kidneys. I would trust this study most of all in this regard.
All in all, you have two opposing opinions locally and mine from far away and in reality, the least reliable given that I have not examined you, your x-rays or sat down and delved into your history. It sounds as though you need another opinion from someone who can do all those parts of your evaluation that cannot be done from afar. I would suggest a urologist, possibly in an academic practice.
The adrenal finding is probably not significant. Can get a baseline ultrasound and if the lesion is visible, it can be followed using this modality (which has no known long term bad effects).
Good luck!
S.A.Liroff, M.D.
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