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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16 Responses to Ask us: Treatment options for a 6mm kidney stone

  1. Muhammad Arif says:

    AoA,
    I am ARIF and my age is 38 years. I have a stone in right kidney at lower pole since 2008. Detail is as under:-
    2008 : 3.0 mm
    2013: 6.4 mm
    2014: 5.2 mm
    Please tell me the treatment.
    Thanks

  2. Manish Kumar Agrahari says:

    Hi My Name is Manish, I am 29 year old, recently I found a sotne 4.72 MM in leftside ureater lower stage. I want to know it is possible to remove this stone from medicine & how much time it will take remove. Now I am feeling pain after 3-4 hours alwayes. it is requested to suggest me best solution of remove stone.

  3. Prashant says:

    I have 6.2 to 6.7 mm kidney stone in left upper ureter.can it will be pass .?

  4. navratan says:

    right renal upper calyx calculus of 6.6 mm with focal caliectasis and cortical cyst of 20 mm.

  5. Jagtap Nandkumar says:

    I have kidney stone of 6 mm in Lower pole of kidney…but now it is in mid pole of
    Kidney. Is it possible that kidney stone can move from Lower pole to Mid pole

  6. Avinash Pandhare says:

    A kidney stone was detected of 6mm before 15 days,nd now after treatment of medicine the pain s released.And having a bit of pain sometimes,should i have operation or not?

  7. ankit says:

    My friend got a stone in left ureter. Its sze is 6mm. Can it be removed with medicines or we have to go for shock wave treatment. She got pain 2 days back n still have it. Pain killers have been suggested by doctors.

  8. Julia says:

    Hi I my name is julia i m 16 and i have 9mm calculus in my right distal ureter will its gonna pass away on its own or operation is necessary or something . I don’t care about the operation all I know is it hurts alot whenever I move any suggestions for me ?

  9. Ginger says:

    I have a 7.8 lower pole stone, dr said it shouldn’t hurt and leave it alone. Hurts ony side especially at night and morning, if I leave it will it damage my kidney, how long should I ignore it, it’s been almost 2 months, very uncomfortable

    • Manoj Monga says:

      If it is causing discomfort, then it is reasonable to try treating it. What we can not say for certain is if your discomfort will resolve with removal of the stone – we can only say that with more certainty if the stone is blocking the kidney. It is rare for a stone to cause damage to a kidney, especially if it is not blocking it.

  10. Nik says:

    Respected Advisors,

    I am male of age 24yrs and have a stone of 4.9mm in my left kidney mid calcus. Its been 30+days nw its not yet moved from the place as conducted 2ultra sound test whch concluded it. On the same it was noted increase size from 4.2mm to 4.9mm.

    I am woried for the same, im continue drinking water and barley/lemon water!

    Can you sugest some treat or medicine for same?

  11. Mr. Riaz says:

    My wife have stone in right kidney 6mm and as per her docter report its out of kidney now. now it will pass by own or what?

    • Manoj Monga MD says:

      A 6 mm stone would have a 40-50% chance of passage. If the stone is out of the kidney now (i.e. moved into the ureter) then taking an alpha-blocker like “flomax” can help it pass. The options if it does not pass would include ureteroscopy or shockwave lithotripsy – one would need to review the x-rays and review your wife’s medications to recommend which would have the highest chance of success.

    • KidneyStoners.org says:

      To pass completely, a kidney stone has to first exit the kidney but then still has to travel down the ureter before entering the bladder. Once it is the bladder, it is likely to pass. This process can take days to weeks. You can see more information on this here: http://www.kidneystoners.org/information/what-chances-successfully-passing-stone-a-kidneystoners-org-infographic/

  12. Niraj says:

    I have a lower pole kidney stone of 4.8mm size how likely is it to pass on its own

    • Manoj Monga says:

      50% chance it will pass if it moves – difficult to know when or if it will move. other risk, being in the lower pole, is there is a 50% chance it will grow over time if left alone.

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