Ask us: Treatment options for a 6mm kidney stone

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? ”

Answer:

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.

About Dr. Manoj Monga

Manoj Monga, MD, is a Professor of Urology at the Cleveland Clinic Foundation, in Cleveland, Ohio.
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76 Responses to Ask us: Treatment options for a 6mm kidney stone

  1. Shalvin says:

    Hi

    There are no urologists in my country. I have a 6mm calculli in the upper pole of the right kidney. This is yet to cause pain. I have an 8mm calculli in the left vesico-ureteric junction.

    What should I do and what are the chances it passes through itself and how should I prevent it from happening again.

    Thanks

  2. Anki says:

    Dear Dr. Actually my wife has stone in left lower ureter with mild hydronephrosis and and hydro ureter from last one year… I did the homeopathic/ allopathic medicine recently admitted under ms surgeon he said the stone will remove with the help of saline and Lasix but recently I did the ivp test.. It shows there is mild hydronephrosis but stone is not showing I went to urologist he suggest for CT scan and creatin test
    Pls suggest me what should I do..?? *

  3. Peshilshing says:

    Doctor iam 19 years old and i have 8.9mm calculus in lower left calyx suggest me a treatment.

  4. Peshilshing says:

    Doctor iam 19 years old and i have 8.9mm calculus in lower left calyx suggest me a treatment

  5. Shiwangi priya says:

    I have 6.5 mm in diameter kidney stone on right side. Its very painful. Will it pass by its own? How ? Kindly suggest me ways to heel the pain and pass it faster.

  6. Vishal says:

    I have following kidney stones
    1. Left vesicoureteric junction Calculus with grade 1 left hydronephrosis & hydroureter. Bilateral renal calculi
    11 mm Calculus at the left vesicoureteric junction
    2. 4.5 mm right upper calyceal & 7.3 mm midcalyceal calculi
    3. 3.4 mm & 2 mm left midcalyceal & 5.5 mm Lower calyceal calculi.

    Please suggest what to do for the above

    Vishal

  7. Sergio says:

    Doc,
    My CT-scan showed that I have LT MID ureteric stone (9mm) opposite L3/4 with proximal LT hydroureter & hydronephrosis.

    My doctor ask me to undergo shock wave therapy.

    I am having a second thought about operation since I am NOT having pain at all.

    Why I don’t have pain considering this 9mm big stone in the urether?

  8. banti says:

    sir i was feeling acidity and not intrested to take food and was suffering digestion problem fm last 1 years .recently i did ultrasound and Dr told to me that i hav 6 mm kdney stone in left but i never feel any type of pain nd problem in urine .which treatment is good for us .

  9. Mohan says:

    I have 7 mm sized RT vesico-Ureteric junction calculus.

  10. Albert Nucain says:

    I heard that lithotripsy is quite expensive. Does most insurance companies cover this procedure?

    • bob says:

      I was scheduled for one . Cost for facility without doctor bill is 6K to 15K.

      very expensive. hospital costs the most.

      my stone is 6 mm . I will wait to pass it. maybe never.
      my stones seem to disappear over time. I caught one in 2009 and it was calcium oxalate.

  11. Manoj monga says:

    An 8mm stone only has a 20% chance of passage. I would suggest considering a shockwave lithotripsy. If your stone is not too hard and not too deep in ct scan it has an 80% chance of success. 65% success if in the lower pole

  12. Jessica Harrell says:

    I have a 7.7mm kidney stone on left side. Will this size stone pass o it’s own or will I need intervention to remove it? Thank you sir in advance.

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