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What would be your recommended course of treatment?

46 year old female lithtripsy of renal calculi.


Comparsion is made to study of 2/16/2004. There has been removal of the previously seen left
ureteral stent. A sigle calculus is seen overlying the lower pole of left kidney that measures 4 mm in
size. At least two (2) calculi are seen in the right kidney, one in the upper pole and one in the lower
pole. A few diffuse smaller fragments are seen in the region of the right renal pelvis. A few
phleboliths are seen in the pelvis. No calculi are seen along the course of the ureters.

Impression: Interval removal of the left ureteral stent. A 4mm calculus in the left
kidney in the lower pole. At least two (2) calculi and small amount of debris is
seen in the right kidney as described.

What would be your recommended course of treatment?

Does it look like another lithotripsy, cystoscopy, both, or neither?

What is the smallest size stone that can be lithotripied?

Can we get away with just a lithotripsy?

Will a 4 mm stone pass on it's own?

They didn't mention a size on the two (2) calculi seen on the right? Would you recommend just seeing if these will pass on their own?

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233190 tn?1278553401
To answer your questions:
1) Depending on the position and size of the stones, the options are shock wave lithotripsy or flexible ureteroscopy.  The more distal the stone, the more likely the use endoscopic techniques.  

2) Typically lithotripsy is used for stones less than 1cm.  This can be considered in your case.

3) I am not aware of a minimal stone size.  Typically lithotripsy is more effective for smaller stones.

4) It may be possible to use lithotripsy alone.

5) It is possible that the stone may pass on its own.

6) If the stones do not cause symptoms, you may want to try to see if they can pass on their own.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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