I have E. coli infection and getting pain in stomach and groin. Please advise some treatment.

Hello,

Welcome to icliniq.com.

I read your query and understood your concern. You have bilateral renal pelvic obstruction due to stones and also have diabetes with a urinary tract infection. The pain in the groin is caused by pelvic renal calculi, and the pain can radiate to the groin area. To treat the infection, I suggest you take a tablet of Levofloxacin 500 mg once a day for 14 days and Amikacin 500 mg injections twice a day for 14 days (if serum creatinine is less than 1.6 mg/dl). Afterward, the stones will need to be cleared bilaterally to fully resolve the infection, as the pus is associated with the presence of stones. Additionally, the stomach upset and abdominal pain you are experiencing are likely due to Nitrofurantoin, which can cause gastritis and acidity. Nitrofurantoin may not be the appropriate choice for treating this infection, but it can be taken for maintenance therapy. I suggest you get your diabetes treated and have your serum creatinine checked once you start the Amikacin injections. The presence of stones can prevent the complete clearance of the infection, so treatment for them is crucial for effective treatment. I suggest you consult a specialist, talk with them and take the medications with their consent. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. I have reviewed your reports (attachment removed to protect the patient's identity) As per the CT (computed tomography) scan results, there are stones in both kidneys causing minimal obstruction. There are three treatment options available in your case as mentioned below:

1. PCNL or Miniperc (Percutaneous Nephrolithotomy or Minimally Invasive Percutaneous Nephrolithotomy): This procedure involves removing the stones through a small puncture in the back, which goes through the kidney and enters the renal pelvis. The stones are then crushed using laser or mechanical energy, leading to complete clearance (100 %) of the stones.
2. RIRS (Retrograde Intrarenal Surgery): In this method, stones are removed through the natural urinary passage, that is the penis. Flexible ureteroscope and laser are used for the procedure. It is the costliest option among the three and carries a risk of kidney infection due to high-pressure irrigation. The chances of stone clearance with RIRS are around 95 %.
3. ESWL (Extracorporeal Shock Wave Lithotripsy): This is an outpatient procedure where stones are crushed using focused magnetic or water pressure waves. It is the least invasive of all options, but the chances of stone clearance are only 60 %.

You will need to decide which treatment option you would like to proceed with. There is always a chance of recurrence, as stone formation is often related to metabolic issues. Addressing the underlying metabolic problem based on stone analysis is essential to prevent future stone formation. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. I have also reviewed the reports you attached (attachments removed to protect the patient's identity). RIRS (Retrograde Intrarenal Surgery) is performed using a larger scope, and since here ureters are relatively small, pre-stenting is required. The stent insertion will lead to the dilatation of the ureter, facilitating stone retrieval in the next procedure. ESWL (Extracorporeal Shock Wave Lithotripsy) is unlikely to completely clear the stone unless only small fragments of soft stone remain. The pain you are experiencing is due to the stent and will persist as long as the stent remains in place. However, in most cases, the pain is bearable. If the pain becomes unbearable, I suggest you consider getting the stent removed. Changing the doctor may not be necessary, instead, I suggest you discuss with your doctor the option of clearing the stone in a second sitting using RIRS instead of ESWL. This is a more sensible approach, as performing RIRS with a stent in place is easier, and the narrowness of the ureter would have improved after stent insertion. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. As I mentioned earlier, the reason for not performing RIRS last time could be due to tight ureters. However, now that you have a stent, your ureters would have dilated, making RIRS easier to perform. It is my practice not to do procedures on both kidneys simultaneously to avoid the risk of infection transferring from one kidney to the other. Treating both kidneys at the same time could be challenging. So, your doctor's suggestion of doing one side at a time is appropriate. Regarding the bad smell from your nose, it may be due to sinusitis. I suggest you consult a specialist and talk with them regarding your sinusitis issue. Rest assured, the smell is not a result of any bacterial infection in your kidneys. I suggest you follow up after your RIRS procedure. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome to icliniq.com.

I read your query and understood your concern. I suggest you allow a minimum of four weeks between two procedures as this duration aids the healing process for the kidney. In cases of emergency, the time between procedures can be less, but that is not applicable in your situation. Although the process may be mentally challenging, it provides sufficient time for the kidney to recover. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. Regarding your questions, following are my opinion:

1. The primary goal is to eliminate the stones with minimal complications, so the number of procedures is not a concern as long as there are no complications.
2. Exercise is beneficial for your overall health, and there are no contraindications for engaging in physical activity.
3. Fruits can impact blood sugar levels, so it is advisable to consult a physician or diabetologist regarding their role in managing diabetes.
4. Allergies should not be a major concern if relieved by cetirizine or any other suitable medication.
5. It would be helpful to have stone analysis from both kidneys to provide you with a comprehensive diet plan.
6. Sugar-free potassium magnesium citrates with vitamin B6 in various trade names can aid in preventing stone recurrence.
7. Losing excess weight is beneficial, and your physician's recommendation to reduce weight is appropriate.

I look forward to receiving the stone analysis from both kidneys to offer you a comprehensive diet plan. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome to icliniq.com.

I read your query and understood your concern. Basically, bleeding always occurs due to the presence of the stent, and that cannot be the reason for your weight loss. I feel this is due to repeated procedures, resulting in infection. If you are getting treated for diabetes at a reputed hospital, I suggest you seek a second opinion regarding your kidney stones at there as well. Typically, RIRS should be completed in three sittings bilaterally that is stenting both sides in the first sitting, RIRS on one side in the second sitting, and RIRS on the other side in the third sitting. So, if that is not the case, please take a second opinion. The symptoms of feverishness and weakness are signs of infection. I suggest you get a urine culture done and get treated accordingly. You need to continue all medications for diabetes as prescribed. There is no relation between your eyesight and RIRS. I suggest you continue the drugs you are taking for urological problems. There is no harm in taking a Hematinic . But I strongly suggest you take a second opinion regarding RIRS and infection to a specialist, talk with them and take the medications with their consent. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.