A 40 year old female with a history of kidney stones with a left ureteral stent placed 2 years ago presents for urinary pain associated with increased urge and frequency. She denies fever or flank pain. It does not feel similar to her previous kidney stones. Vital signs are within normal limits. On exam, she is comfortable appearing and has mild suprapubic tenderness to palpation. Point-of-care pregnancy test is negative. Urinalysis results with 3+ leukocyte esterase, 2+ nitrites, and 105 WBCs/HPF. Which of the following is the appropriate management of this patient’s condition?
A: Admit for IV antibiotics
B: Consult urology for stent removal
C: CT of the abdomen and pelvis
D: Discharge with oral antibiotics
Answer: discharge with oral antibiotics
This patient is presenting with findings consistent with acute cystitis, a urinary tract infection localized to the bladder. Urinalysis findings with elevated leukocyte esterase, nitrites, and WBCs with clinical symptoms are supportive of the diagnosis. Treatment of minor urinary tract infections in patients with ureteral stents is oral antibiotics and do not require stent removal. If pyelonephritis or systemic infection with a ureteral stent is suspected, consultation with urology, IV antibiotics, and radiographic imaging to determine the location of the stent is warranted.
References:
Askew KL. Urinary Tract Infections and Hematuria. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw Hill; 2020.
Josephson EB, Azan B. Complications of Urologic Procedures and Devices. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw Hill; 2020.
