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Have history of sand like kidney stone. Having pain during urination and after ejaculation. Remedy?

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Hi Doctor, I have a medical history of sand like kidney stone which passes away, it was only detected when I was 16 and I had extreme pain at that time. After the incident I occasionally have pain in my urethra while passing urine or after ejaculation, this pain generally goes away next morning. I'm 36 now, yesterday when I had the pain, I opened my urethra walls and observed clumpy white sediments inside. The pain was not much, but I had slight burning sensation, so next morning I decided to catch the sediments in a urine exam. The results of the exam are: Straw, slightly Hazy, gravity 1.015, Acidic/Protein/ Phospate/sugar/Acetone/ketone: Nil, Occult Blood/Bile pigment: Nil, Bile salt: absent, Pus: 0-2 hpf, Epithelial Cells 7-8 hpf, Red blood cells/Cast/Crystals/Micro organisms/Others: Nil

I'm worried on that high count of Epithelial cells.
Posted Thu, 26 Sep 2013 in Urinary and Bladder Problems
Answered by Dr. Preeti Parakh 1 hour later
Brief Answer:
Your urine report is normal.

Detailed Answer:

Welcome to Healthcare Magic!

I have gone through the urine test report that you have attached. The presence of epithelial cells 7-8 per high power field is is not a cause for concern as around 15-20 epithelial cells may normally be present per high power field. Even the rest of your report is normal. No crystals, that could have suggested stones in the urinary tract, were found. There are no features suggestive of urinary tract infection as well.

Sometimes, slight abrasions occur during sexual activity which sting when they come in contact with urine. This could be a possible reason for the mild pain. The white clumps that you saw could have been the residues from seminal secretion. One other possibility is fungal infection but that appears unlikely to me as in that case you would have had other symptoms as well like redness, itching etc.

Hence, in my opinion, you need not worry.

Hope this answers your query. Feel free to contact us if you want any clarifications.

Best wishes.

Dr Preeti Parakh
MD Psychiatry
Above answer was peer-reviewed by
Follow-up: Have history of sand like kidney stone. Having pain during urination and after ejaculation. Remedy? 38 minutes later
Hi Dr,

I've not had sex since last 3-4 weeks. Infact i'm taking it slow on sex since last 3-4 months due to fungal infection. Also, let me mention that when I'm in pain, I can generally feel some spot below by urethra tube more painful with external touch, as if something sharp is stuck inside. The position of this pain changes every time. I'm also attaching another urine report which has crystals, this was done 3 months back when I was diagnosed with the fungal infection. However, post that a KUB was also done, but it came out clean, as generally by next day I feel nothing and thus it is difficult to catch the same in KUB.
Answered by Dr. Preeti Parakh 2 hours later
Brief Answer:
Presence of stones is highly unlikely.

Detailed Answer:

Thanks for writing back!

I have gone through the reports you attached with the second query. The urine test in May showed the presence of calcium phosphate crystals but again it is not a cause of worry as some amount of crystals are normally present in urine. Presence of calcium phosphate crystals in alkaline urine is a normal finding. This is the reason why your ultrasonography examination also could not detect stones. Moreover, it could not detect any other abnormality also.

Regarding the pain, it is difficult to say what can cause a pain that changes its position and feels as if something is stuck inside, but is tender to external touch. Even infection is not likely to be fleeting. But one thing is for sure. If it were a stone, the pain would have been severe and there would have been at least some bleeding and your urine would have shown the presence of some red blood cells. Moreover, the ultrasonography would have picked up something.

Fungal infections often remain active in the background and intermittently flare up. This is the only thing that you should beware of, in my opinion and I hope you completed the course of anti-fungal medicines as prescribed. I guess that your first experience of passage of stones was very painful and it is understandable that you have become very cautious and wish to prevent a recurrence. But there is no need to worry at present. Your reports are quite fine.

Hope this answers your query.

Best wishes.

Dr Preeti Parakh
MD Psychiatry
Above answer was peer-reviewed by
Follow-up: Have history of sand like kidney stone. Having pain during urination and after ejaculation. Remedy? 18 hours later
Thanks for your reply Doc.

If we rule out stone, and infection, we are also ruling out all UTI related STD/STI right ?

The doctor gave me 6 weeks of AF-150, I found the fungal infection cured by say 70%, so I took the medication for another 4 weeks (all 1 tab a week). That cured me by 95%, rest 5% i'm still fighting with, as I still find redness and stickiness on the glans after sex. I've stopped applying Candid-B after 1 month as the doc previously prescribed, and have been applying coconut oil and dusting with candid powder. I guess this last 5% will be treated over time only ? and do you think that pain has to do anything with this fungal infection ?
Answered by Dr. Preeti Parakh 27 minutes later
Brief Answer:
I feel you may need to restart fluconazole.

Detailed Answer:

Thanks for writing back!

Yes, stone and bacterial infections seem highly unlikely. So what remains is fungal infection. In my opinion, although most of the infection was controlled by the treatment you took, some residual infection is still persisting and probably that is why you are having only occasional symptoms and no significant abnormalities in your lab tests.

The duration of fluconazole (AF 150) treatment is not fixed and depends on the response to treatment and severity of symptoms. I do not expect that the residual 5% symptoms will abate with just clotrimazole powder and I feel that you will need to restart fluconazole. Please consult the doctor who prescribed fluconazole and ask if you should restart it. Usually fluconazole has to be continued for a few more weeks after symptoms disappear, to completely stop fungal growth.

Since it is possible for candidiasis to be sexually transmitted, please also get your partner checked.

Hope this helps you. Feel free to ask if you want any clarifications and if you have no further queries, please close the discussion and rate it .

Best wishes.

Dr Preeti Parakh
MD Psychiatry
Above answer was peer-reviewed by
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