In our “Ask a kidney stone doctor” section, we field questions from stone formers or their family members. See other questions and answers or ask your own question here.
January 10, 2012
Question about treatment options for a 6mm kidney stone:
“About 10 years ago, I had a kidney stone that passed over the course of a few days. It was also on the right side, but I never found out how big it was or what kind of stone it was.
I recently had severe pain on the right side of my back for a few hours. The pain went away. I had a CT Scan of my Urinary Tract which revealed:
“There is a right ureteric calclus measuring 3mm in diameter at the level o the L4/L5 intervertebral disc. There is mild prominence of the right pelvicalyceal system and proximal ureter above this. There is no other reteric calculus but the is a 6m calculus in the right lower pole calyx. The kidneys are otherwise normal in appearance. The other solid viscera of the upper abdomen are normal allowing for the non contrast study. Conclusion: 3mm mid right ureteric calculus, with mild prominence of the right ureter superior to this. second non obstructive calculus in right lower pole calyx.”
I don’t know if the 3mm stone has passed yet. I only have intermittent very slight aching on the right side of my back. I am more worried about the 6 mm stone. What would be the best treatment for the 6mm stone? I have read that stones in the lower pole can be more difficult to successfully blast. Would blasting be an option? What are the chances it will pass on its own? Is there anything I can do to encourage it to pass on its own safely? If I do nothing, what is the likelihood it will remain asymptomatic indefinitely? Is watch and wait a safe option for me? ”
First step is to make certain you pass the 3mm stone. If you don’t pass it then you could undergo ureteroscopy and the 6mm stone could be addressed at the same setting.
Next, on the CT one would measure the stone density and skin to stone distance. This would further guide us as to whether shockwave would work. For a 6mm stone in the lower pole success with shockwave would be 70% if the density and distance were favorable. Other options are to observe the stone if it is not causing pain or ureteroscopy which has a 90% success but is more invasive.
A previous question on our website may be of interest to you when considering observing the stone. While the question then was about a 3mm stone, the information also applies to a 6mm stone such as yours.
(UPDATE 1/11/12) Additional comments from Dr. Marshall Stoller: I would also bring to light that your stones have always been on your right side. We have undertaken some studies that have shown most patients with recurrent unilateral stones sleep stone side down. Studies have shown dramatic changes in renal blood flow resulting in a hyperfiltration phenomenon. I would recommend that you attempt to change your sleep posture, if indeed you do sleep on your right side. Additionally, I would reduce your sodium intake, reduce animal protein consumption at individual meals, and ensure that you drink enough fluids to void >1.5 liters per day.
Please note that this information is not intended to represent medical advice or professional opinion. Each patient’s case is unique and we recommend that all patients seek care with their local medical professional.