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4mm silent kidney stone not found during lithotripsy
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4mm silent kidney stone not found during lithotripsy

I am a 42 yr old female.  I had a ct scan done to check my gallbladder, which also showed my kidneys were clear of stones, however 2 wks later a 4mm kidney stone was found during an ultrasound.  I was referred to a urologist and the doctor told me that a 4mm stone only had a 60% chance of passing on its own so we scheduled lithotripsy. It was three months before my appt for the lithotripsy because I did have my gallbladder removed in the meantime. I woke up from the anestheia and was told the lithotripsy was not performed because the doctor could not find the stone!  She checked everywhere to see if it had moved with no luck.  She said she saw a shadow but was not sure if it was a stone because she said I had a lot of gas which made it hard to see and she didn't want to proceed unless she was sure (I didnt' feel like I had a lot of gas??).  I am scheduled for another ct scan.  As far as history, I had a UTI last year with ALOT of pain and blood in my urine with a back ache the week before that the doctor thinks could have been a stone.  My question is how risky is it to do nothing about a "silent" 4mm kidney stone?  Also how common is gas a problem during lithotripsy?  I was very disappointed as I spend time, money, worry and still haven't gotten rid of the stone (if there was one or still is one).  I am concerned that I would not be able to pass it on my own.  Thanks for any advice you can give me.
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A stone in the kidney can stay there for years. If it is not infected and not causing any obstruction then it is without symptoms. It may give you a small amount of blood in the urine (often this is only visible under the microscope). If the stone moves into the ureter (the tube from the kidney to the bladder), then its size has an effect on its chance of passing spontaneously. A 4 mm stone has about an 80% chance of spontaneous passage at that point. That does not mean that it will pass quickly or without pain, just that its likelihood of passing is that high. CT scans with narrow "cuts" of 2.5 mm (or less) should be quite sensitive to finding stones and are much more reliable than ultrasounds.
Getting to your procedure, if the urologist cannot locate the stone (maybe it passed silently?) or could not be identified on x-ray because of many technical factors that can influence the study, gas being one of them, then there is essentially nothing to treat. It was definitely in your best interest not to treat what could not be found!
I see no need to treat the stone at this point. I would get a follow-up x-ray of your abdomen (not a CT due to the radiation involved) in another year unless you have an absolute need to know or are planning to travel to places where medical care will not be readily available. If your stone is then found and is growing in size, then I would recommend ESWL as well as a medical workup to determine what to do to stop making stones.
S.A.Liroff, M.D.


"This information is provided for general medical educational purposes only. It
does not  necessarily reflect the opinions of Henry Ford  Hospital  or the
Vattikuti Urologic Institute.  Please consult your physician for diagnostic
and treatment options pertaining to your specific medical  condition.”





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