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QUESTION: I was recently diagnosed with a kidney stone of about 3mm, after a trip to the emergency room, as i had all of the symptoms. After 4 days, the stone passed while urinating. I went to my doctor, who sent me to get an ultrasound test to make sure that there are no more stones. The result of the ultrasound is a 5 mm stone in the lower part of the kidney, but without symptoms so far. I was told that I shouldn't worry if there are no symptoms. What do you think is my best option? Thanks for your time and advice.

ANSWER: Frank:

This is a bit controversial Some physicians believe that you should wait on stones that are small enough to pass by themselves since otherwise you are treating many stones that wouldn't need it.  On the other hand, larger stones (bigger than 4 mm) have a harder time to pass without causing pain.  Besides, patients should have some say in what they want to do sicn ethey are on the recieving end of the pain.

My personal opinion is that any stone 3 mm or larger that can be easily seen on x-ray (not ultrasound!) can be considered a candidate for treatment with the kidney stone machine or ESWL.  Treatment is relatively easy and almost always successful.  So I tend to lean towards treatment of such stones, but many of my colleagues disagree.  In such cases, it only seems reasonable to inform patients of the pros and cons and let them decide.

You may also want to ask about kidney stone prevention testing.  This requires a 24 hour urine test, but is often very helpful in reducing new stone production.

---------- FOLLOW-UP ----------

QUESTION: I had the kidney  stone  chemically analyzed,that I passed while urinating, and the result was: Calcium Oxalate. I have two questions:

1) Diet:What foods do I absolutely have to avoid?

2) Prevention medicine: I was advised to take, which in Italy is called Lithos( which are potassium citrate and magnesium pills, for a period of 2 months, then every alternative month.
What do you think?

Thanks in advance for your time and advise.

Frank

Answer
Frank:

If you read my prior response carefully, you'll see that to reliably identify the problems causing stones we need a 24 hour urine collection test.  The stone composition is helpful, but it does not indicate if the problem is calcium, oxalate, uric acid, citrate or something else.  Only the 24 hour urine test can determine this.  

In cases where we only know the stone composition, we generally recommend moderation of dietary calcium (not too much, not too little), a reduction in higher oxalate foods (typically nuts, chocolate, green leafy vegetables like spinach) and drinking more water.

If you are serious about kidney stone prevention, ask your physician about ordering a 24 hour urine test for kidney stone prevention.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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