From the Guidelines
The management approach for a 28-year-old male with bilateral nephrolithiasis, left abdominal pain, and a history of dysuria should focus on pain management, hydration, and prevention of recurrent stone formation.
Initial Management
- The patient should be advised to increase fluid intake to achieve at least 2 L of urine per day to help prevent recurrent nephrolithiasis 1.
- Pain management should be initiated, and the patient should be monitored for signs of infection or obstruction.
Diagnostic Evaluation
- A non-contrast CT scan should be obtained to evaluate the size and location of the stones, as well as to rule out any complications such as obstruction or infection 1.
- A urinalysis should be performed to check for signs of infection or hematuria, and a urine culture should be obtained if infection is suspected 1.
Prevention of Recurrent Stone Formation
- The patient should be advised to reduce dietary oxalate, reduce dietary animal protein, and maintain normal dietary calcium to help prevent recurrent stone formation 1.
- Pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol may be considered if increased fluid intake fails to reduce the formation of stones 1.
Surgical Management
- Surgical management may be necessary if the stones are large or causing obstruction, and the patient should be referred to a urologist for further evaluation and management 1.
From the Research
Diagnostic Approach
- The patient's symptoms of bilateral nephrolithiasis, left abdominal pain, and a history of dysuria suggest a possible urinary tract infection (UTI) or obstruction, as noted in 2.
- An unenhanced helical CT scan of the abdomen and pelvis should be performed to confirm the presence of a urinary stone, as recommended in 3.
- The CT scan can also help identify any potential complications, such as infected hydronephrosis, which may require prompt drainage, as discussed in 4 and 2.
Pain Management
- Pain management can be achieved using NSAIDs, opioids, or a combination of both, as suggested in 3.
- The choice of pain management strategy will depend on the severity of the patient's symptoms and the presence of any underlying medical conditions.
Treatment Options
- The treatment approach will depend on the size, location, and composition of the renal calculi, as well as the presence of any complications, such as infection or obstruction, as noted in 3, 4, and 2.
- Percutaneous nephrolithotomy or extracorporeal shock wave lithotripsy may be required to eradicate infection stones, as discussed in 2.
- Open stone surgery may be considered in selective cases, such as large or hard stones, or in cases with infected hydronephrosis, as reported in 4.
Differential Diagnosis
- It is essential to consider other potential causes of the patient's symptoms, such as a Page kidney, which can cause secondary hypertension, as described in 5.
- A thorough diagnostic evaluation, including imaging studies and laboratory tests, is necessary to rule out other possible causes of the patient's symptoms.