Hello doctor, I am a 38 year old man, 280 lbs. I have a 4 mm kidney stone that I went to the ER for on 12th last month because of the pain. The CT scan said "A 3 x 4 mm calculus is present in the proximal left ureter at the level of L3. There is mild dilation of the proximal left ureter and renal pelvis, but no hydronephrosis. Left proximal ureteral calculus measuring 3 x 4 mm. There is mild associated dilation of the proximal left ureter and renal pelvis." On 25th, I was back in the ER with bad pain and had another CT scan. The scan said "The lung basis are clear. There is no fluid in the pleural space on either side. No pneumothorax is seen. A 4 mm stone is again seen in the proximal left ureter in unchanged position causing mild dilatation of the ureter and the renal collecting system. Again, there is only minimal stranding in the fat surrounding the proximal ureter. No interval change. Partially obstructing stone in the left proximal ureter. Fatty infiltration of the liver and borderline sized spleen. I went back to the ER on 26th due to pain and they recommended against another CT scan due to radiation. I got Morphine and survived but I do not know if the stone moved. Now, on 10th this month, I went back to the ER because of pain and did not do a CT scan so I do not know where this stone is. I do not know what to do. I think it may be in my bladder waiting for me to pee it out, but what if it is stuck in the exact same spot from 30 days ago? Should I go ahead and do another CT scan? I am in no pain now. Each time I went to the ER, I was blood and urine tested and my kidney function is fine and there are no infections. I am just worried this stone is sitting there. Or do you think it has passed to the bladder? I do not think there is any way to know unless I get another CT scan but I am a little worried about radiation. Thoughts?
Hi. I have gone through your query. You have a tendency to form kidney stones repeatedly. It is something that you need to get evaluated once the treatment for the present condition is complete. Regarding your present problem, a 4 mm stone will be passed out spontaneously in 90 % of patients, with good hydration and medication. If you are not symptomatic, it is reasonable to wait for a period of three weeks to assess again. For you, it is possible to do an ultrasound scan to check whether there is any dilation of the ureter, which if present, then a CT scan will be necessary. If absent, you can avoid a CT scan if you are asymptomatic. Also, if the stone has not passed out during this time, you may require surgical stone removal, even though the stone is only 4 mm. For more information consult a urologist online -->