Ask us: Do I need to treat my 3mm stone?

In our “Ask a kidney stone doctor” section, we field questions from stone formers or their family members. Today’s question is about small non-symptomatic kidney stones. See other questions and answers or ask your own question here.

 

July 22, 2011

Question from Minnesota:

I have a 3mm to 4mm stone in my right kidney, which has been there since 2003.  It originally was very high up in the kidney, but moved to the lower part of the kidney in 2006. I just had another CT done, and it is still in the same place and the same size.  Because the stone is in the lower part of the kidney versus the higher part, is it less likely to pass, because it would have to go up to get into the ureter versus down? Because I’ve had this stone so long with no changes, what are the chances that it will just continue to sit there and never pass?  It has caused me no pain other than occasional blood in my urine. I was told by my doc that I could wait and watch the 3-4mm stone in my right kidney or proceed with ureteroscopy to remove it. It’s been sitting there since 2003 without giving me any discomfort. How painful is having a stent put in to promote healing after the ureteroscopy and is it really necessary?

Answer:

Many patients are found with small stones and it can be confusing deciding on whether to proceed with treatment or to continue observing the stone(s). Several factors need to be considered to help make a decision:

1)    Size: Stones that are smaller than 5mm are more likely to be able to pass successfully without requiring surgery. When a stone is larger (>6mm) and unlikely to pass successfully, it may make more sense to intervene. In your case, the stone is small and if it were to start moving down the ureter, it would have a good chance of passing spontaneously. However, successful passage does not mean non-painful passage as even small stones can cause significant discomfort when they move down the ureter. Because of this, patients who have already experienced a stone episode in the past are usually more motivated to have an early intervention so that they can avoid another stone passage episode.

2)    Stability: Stones that are growing are more likely to lead to problems while stones that stay the same size are less likely to become symptomatic. As your stone is stable over 8 years, one could argue to continue to watch it.

3)    Location: Stones that are not obstructing, like yours, are generally asymptomatic. Stones that are floating in the renal pelvis or ureter are more likely to cause obstruction and more likely to require intervention. Stone fragments in the lower pole are generally felt to be less likely to pass. However, in addition to whether the stone is in the upper pole, middle-pole, or lower pole of the kidney, researchers have focused on the “calyceal anatomy” which can be though of as the length of the “tunnel” and the angle of the “tunnel” that the stone would have to travel to end up in the center part of the kidney where it could start making its way down the ureter.

4)    Symptoms: Stones that cause symptoms such as pain, recurrent infections, or significant bleeding would be more likely to require intervention than stones that are causing minimal symptoms.

5)    Other things to consider: Certain individuals will be advised to have their stone treated even if it is small and asymptomatic. This includes pilots, who would put themselves and their passengers at risk if they were to experience a stone passage episode while flying, and travelers to remote locations, where modern medical facilities may not be available if they were to suffer a stone attack.

The short answer as to how likely your stone is to remain there without causing problems is 80% over the next 3-10 years. Another way of looking at this is that 20%, or 1 out of 5 patients in your situation will experience a stone passage episode over the next 3-10 years while 4 out of 5 will do fine without experiencing problems. Here’s the long answer: Based on a study of 5,047 adults who underwent CT colonography screening, asymptomatic stones, such as yours, are found in 8% of American adults. In that study, the average stone size was 3mm. Over 10 years, 20.5% of patients with stones, or 1 out of 5, developed a symptomatic “stone episode” requiring intervention. Alternatively, 4 out of 5 patients did fine without experiencing a stone episode. This rate of 20% of small stones requiring treatment when observed is remarkably consistent with multiple other studies where patients with small stones were observed.

Finally, as to your question about ureteral stents, stents are often required after ureteroscopy surgery because of the ureter’s tendency to swell temporarily and become blocked after this type of surgery. This swelling can cause pain similar to a stone episode. We’ve found that this is more likely to occur in patients who have not had prior ureteroscopy surgery. Note though that this is a “surgeon’s preference” as some urologists will be more likely to perform ureteroscopy without leaving a stent. Stent pain can be mild or can be very uncomfortable. While some patients do not even realize a stent is there, most can’t wait to have them removed and some patients will say that the stent was worse than their stone. One way to potentially avoid a stent is to consider shockwave lithotripsy (ESWL) if the stone is easily visible on a plain x-ray.

About Dr. Mike Nguyen

Mike M Nguyen, MD, MPH, is a urologist and an Associate Professor of Clinical Urology at the Keck School of Medicine of USC in Los Angeles, CA. He specializes in the treatment of kidney stones with both surgery and dietary prevention and the in the treatment of kidney and prostate cancer using the latest robotic surgical approaches. He sees patients at clinics located in Los Angeles, Pasadena, and La Canada, CA. He is the founder of the www.KidneyStoners.org website.
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88 Responses to Ask us: Do I need to treat my 3mm stone?

  1. Vineeta patel says:

    Sir my brother has stone of 3 mm in size in upper third ureter since March 2017 and now 5 December 2017 severe pain in lower abdomen and some blood pass without urine. He has been taking homeopathic Medicine from March 2017, is surgery essential in this case? Can it cause any complications?

  2. Swane Maderaje says:

    Sir ,I done non contrast spiral ct scan of the urinary tract…it shows that I have Mild hydronephrosis with small hyperdense stone measures about 6mm seen at lower and ureter with CD density 880…
    I have to much pain ..U took medicines and follow up after 10days..if not pass out What will be the possible treament?is surgery needed..I’m too worry..

  3. Swarup nag says:

    Sir My Close friend is attracted left kidney stone. Size-2.3mm so what is the treatment.plz sir reply me.

  4. mary c mowat says:

    Quebra Pendra does work 3 capsules per day and tea bags take both

  5. Mary says:

    Has anyone tried Chanca Piedra to help dissolve a kidney stone? If so, were there any side effects?

  6. Betty Reynolds says:

    Please help….I have a 7mm stone and have had emergency surgery less than a year ago for an 8.5 stone, I have lots of pain in my left side and back, how should I have this treated and how soon. Not please with the local care but very please with the Dr. That remove the 8.5 stone.
    Betty Reynolds
    Ashland Ky locally
    North Myrtle Beach Sc for the 8.5 stone

  7. Honest pain from stent is unbearable at night...do you think I'll pass it in time? says:

    I have a 1.2 cm stone in middle of my right kidney. This showed in a CT scan I had done for symptoms not kidney related..I’ve had 4 rounds of laser treatment, there’s a slight reduction in size..my urologist has mentioned laser surgery..I have a stent fitted to let stone pass withr causing me extra trouble… To be honest pain & discomfort fro stent

  8. Zakira Razak says:

    Sir, I have a stone in both side of kidney .Once I did operation. That time my stone size was 9mm in right kidney and 3mm,4mm size in left side.But after 11 month, that is now I did scan again. And now also I found stone both the side. Now the stone size is 3mm in right kidney and 2 mm in left kidney. .pllzzz give good solution. Becze always I’m serching Google for solution .but I didn’t get

  9. Balaji Harihar says:

    Sir I have an calculus measuring 5*5 in lower pool of my left kidney so that is the treatment for it I have tried Ayurvedic and homeopathic medicine but I dint get any positive result so plz suggest an proper treatment for it

  10. Josie Arack says:

    I had a cat scan and it revealed I had a solid mass in the lower left pole of the right kidney 3.1 x 3.0 c. What does that mean as all my other results came out good! I am so worried.

  11. Nidhi Sharma says:

    I have 2 stones measuring 2 mm and 3 mm in mid pole calyces. Sometimes i am facing discomfort in passing urine, rarely associated with blood. What treatment should i take. Can laser treatment be done for 2-3 mm stones . What is the success rate? Is the discomfort due to stones or due to urinary track infection as suggested by somebody.

  12. v nagaraju says:

    I have a 2mm non obstructive renal calculus in lower. pls suggest how to cure

  13. p.b.munasinghe says:

    i have two kidney stones in my left kidney. they are 3mm and 3.8mm in size. they cause me no problem. but a small stone in my right kidney cause me unbearable pain intermittently. please give me a solution. can it be cured by oral medication?

  14. Saba says:

    Sir i have the small concretions in my left renal.the size is not confirmed.. but its hurt me a lot spe whn i have my meal the pain get sharp n move into my hips with burning sensation.. is it due to renal concretions?

  15. sunil says:

    sir, i have 2.6 mm kidney stone in lower pole in right kidney so what is the treament for this so pl. reply

  16. Lee says:

    For those with a relatively small stone that is in the upper pole (said to be more likely to travel into the ureter), but not causing obstruction or symptoms, it’s like being between a rock and a hard space. After experiencing the pain/discomfort of a ureteroscopy and stent, I would never want to go through that kind of intervention again unless totally necessary. On the other hand, walking around with a stone that may pass at any time, causing excruciating pain, is extremely unnerving, sort of like a ticking time bomb. So what does one do in this situation, just try to not think about it? If this gets answered, thank you!

  17. Roger says:

    The story of drinking apple cider vinegar is not true .By the time it leaves the stomach the acid is used up in digestion so by the time it hits the kidneys there is no actual apple cider vinegar acid dissolving the kidney stone .If you have passed stones, depending on the make of them and what kind they are, you can take those passed stones and put them in glass of apple cider vinegar directly, leave them there for several days and see what happens ? For me, they didn’t dissolve .What does that tell you ?

    Diet, exercise and lots of water .Too many times coffee, tea, sodas and the foods we eat cause the stones .It is the start of the kidney stone problem .

  18. Lane bartoni says:

    I have a 3.5 centimeter kidney stone it is causing back and side pain, frequent urination, is it dangerous and what are my options…thank you for your time.

    • ankit says:

      Hi Lane,

      I have 4mm stone in left kidney and have been advised to drink 3-4 liters of water in a day. Additionally drinking apple cider vinegar and lemon juice helps in passing the stone. With in a month you should be able to pass the stone.

  19. gerard gulgulian says:

    hello i just wanna talk about my stone which is 4mm in my kidney and it is not givin me any pains or discomfort and when i did the xray it showed that its on the upper part of my kidney ..what should i do to get rid of it ? or should i drink something that helps it go down..thank you!

  20. Shabnam says:

    Sir my mom have 3mm noted at upper pole of right kidney . What is the treatment needed for this calculus to pass through pl reply me quickly
    Reply

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