xrays on 2/12/99 determined a kidney stone in left ureter

  I have a 20 year history of kidney stones.Most were passed by drinking liquids and waiting over 1 week. I had an operation to remove a stone in 1991 from the left ureter which left some scar tissue.All stones since have been on the left side.
  In 1991 a doctor at Mass Gen removed one by ostiscope. All stones are calcium based.
  QUESTION: Can the current stone be removed by laser, ultrasound, lithotripsy or other means than an operation or use of a stint?
  I am concerned about creating more scar tissue, as I am 63 and expect more stones in the future. I also have 2 other stones in the left kidney per the xrays on 2/12/99.
  I plan to wait 1 week, hoping to pass the current stone problem, but I am ralistic enough to realize I probably have to take more aggressive action.
  Feedback will be appreciated.Any source material that I could be directed to would also be helpful.
  My pcp is in the process of finding me a urologist. I want to be able to ask the right questions.
  Sincerely,
  Jim C.
    

[HFHS M.D.-MS]

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Thanks Jim C. for your question.
You are correct about more aggressive action. The action I recommend  is called prevention.   Once you have had a metabolic work-up (blood and urine test) and  a diagnosis of what is causing your stones, you should be treated diligently.  Drinking excessive water can never hurt no matter what the cause for your stones.    
As for the stone you have now in the left ureter, treatment  depends on the size and location of the stone and the equipment available to your urologist.  If the stone is less than 5 mm, you have a 95% chance of passing it on your own.  This is especially true since you have passed other stones before. A watchful waiting  approach has the least complication rate but needs to be tempered by realistic time considerations.  You must remember to remain under doctor supervision until you pass the stone because chronic  kidney obstruction  can result in the loss of the kidney.
   If the stone is larger / higher up in the ureter or in the kidney , ESWL (extracorporeal shock wave lithotripsy ) is usually the way to go but ureteroscopy ( using a fine telescope) with a laser or stone basket is a good second choice.  If the stone is large or stuck in the lower ureter, ureteroscopy with stone basket, ultrasound, laser or other form of lithotripsy is usually recommended.  A stent is used usually when ureteroscopy is employed  to help avoid obstruction from ureteral edema and prevent problems from small holes in the ureter as well as allow for the passage of fragments from lithotripsy that might cause blockage when they pass.  
Good luck with your visit to the urologist.
More individualized care is available at the Henry Ford Hospital and its suburban campuses by calling  (1 800 653 6568). We can also arrange local accommodations through this number if this is your need. Please bring any physicians