Expert: Stephen W. Leslie, MD - 3/12/2006

Question
Hi.In mid-January this year a CT scan revealed a stone in the upper 1/3 of my ureter. About one week ago (early March) a second scan showed it be in the lower 1/3 of the ureter. I believe the stone is 4 mm. I'm now taking Flomax to encourage its departure.

Question 1: My doc says lithotripsy can't be used for a stone in the ureter. True? Cytoscope is the only option if it doesn't move again?
Question 2. What's a reasonable waiting period before I take action (cytoscope)?
Question 3. Is it true that drinking lots of water at this time will only cause irritation?
Thank you!

Answer
Lithotripsy can be used for stones anywhere in the ureter although it's easier in some locations than others.  In the lower ureter, many urologists recommend ureteroscopy with or without laser lithotripsy as being more precise and actually removing the entire stone rather than standard lithotripsy.  In my view, it depends on the skill and experience of the urologist.  

If the ureteroscopy goes well and easily, then the stone is gone and you're done.  If there are problems, scar tissue, kinks, bleeding or any other problems, then it's a good idea to leave a double J stend and switch to ESWL or lithotripsy.

A reasonable period of time to wait is about 30 days.  If the stone hasn't moved in that time, an intervention is recommended.

It is not true that drinking extra water will only cause irritation.  Where did you get that idea?

You should ask your physicians about 24 hour urine testing and kidney stone prevention.  A number of good 24 hour urine testing programs are avaiable if you are interested in long-term prevention.  The best is probably the "Comprehensive Kidney Stone Diagnostic Panel" from LabCorp, test # 242339.  This test includes all the relevant blood and urine tests plus a computerized analysis.  It is the only testing protocol that reviews all the the clinical history, blood levels and 24 hour urine results to perform an analysis and make treatment suggestions.

You should also get a copy of "The Kidney Stones Handbook" by Savitz and Leslie.  It is the only NIH endorsed book written for kidney stone patients.  You can order it directly from the publisher by calling Grant Gibbs at: 530-889-1727 or by email at: gsavitz@earthlink.net