Q. I have a 4 mm kidney stone but no pain. Should I do another CT scan?

Answered by
Dr. Karthik Rajan
and medically reviewed by iCliniq medical review team.

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?

Dr. Karthik Rajan

Andrology Urology
#

Hi,

Welcome to icliniq.com.

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 --> https://www.icliniq.com/ask-a-doctor-online/urologist

Hello doctor,

Thank you for your reply.

I have just a few quick follow up questions.

  1. Just to confirm, even though the stone has been in me for 30 days, you are comfortable with me waiting an extra three weeks to see if I can pee out the stone? I just want to make sure.
  2. I did have an ultrasound and they said my kidney was somewhat dilated but I do not have the report.
  3. If after three weeks, I have no pain and have not peed out the stone, would you then push my doctor to order a CT scan and see a urologist for removal?

Dr. Karthik Rajan

Andrology Urology
#

Hi,

Welcome back to icliniq.com.

I meant a total of three weeks since detection. In your case, I would advise an ultrasound now, which done properly will detect any dilation and can visualize the stone, if it is in the upper ureter.

If you are asymptomatic, then we can wait a bit longer, but the chances of spontaneously passing the stone are very less after three weeks, though it may be possible.

It is better to do a CT scan the day prior to a surgical removal than right now, as it confirms the presence and location of the stone and prevents an unwanted surgery I would advise a visit with your urologist for discussion of your options, a surgical stone removal and waiting for some more time.

For more information consult a urologist online --> https://www.icliniq.com/ask-a-doctor-online/urologist

Thank you doctor,

I did have an ultrasound two days ago but they did not seem worried and are waiting for me to pass it. If I have no infection, no pain, and am peeing fine, do you think it is safe to wait two more weeks and if I do not pass it get another ultrasound? The problem is my doctor does not believe you can see stones in the ultrasound and will not order me a CT scan.

P.S. I found the results of my ultrasound. Can you let me know what you think?

Dr. Karthik Rajan

Andrology Urology
#

Hi,

Welcome back to icliniq.com.

I have gone through your report (attachment removed to protect patient identity). It is safe for you to wait for two more weeks as you are not symptomatic and you have only mild dilation of the ureter.

The USG report definitely shows evidence of stone obstruction and it would serve well to do a repeat CT, but it is better to do it if a surgical procedure is contemplated. Till then, you can follow up with an ultrasound which will definitely see if there is still any obstruction.

I would suggest you get a specialist opinion in your case as normal conservative treatment has not been successful.

For more information consult a urologist online --> https://www.icliniq.com/ask-a-doctor-online/urologist

Thank you doctor,

I can get another ultrasound tomorrow. What type of ultrasound should I ask for? And, are you okay with me getting an ultrasound tomorrow to make sure there is no obstruction?

Dr. Karthik Rajan

Andrology Urology
#

Hi,

Welcome back to icliniq.com.

I would advise you to wait for at least a week as three days is too short a duration.

There is no special ultrasound for detection of kidney stones. It is just a normal routine ultrasound.

For more information consult a urologist online --> https://www.icliniq.com/ask-a-doctor-online/urologist

Thank you doctor,

I just got an ultrasound and I have uploaded the results. I did pee out the stone on Monday and it was 4 mm. I have a few questions about the ultrasound. It said, "A calcification is seen measuring 10 mm in the left UVJ." I peed out a 4 mm stone, the ultrasound has to be incorrect, there is no way I have a 10 mm stone correct? It said, "A small 3 mm echogenic focus was seen within the right kidney which may represent small renal stone." Does this mean I might have a 3 mm stone located in my right kidney and that it could drop to my ureter at any time and cause pain? Or could it break up and I easily pee it out? What do you think about the rest of the ultrasound results and do you think I am okay?

Dr. Karthik Rajan

Andrology Urology
#

Hi,

Welcome to icliniq.com.

  • I have gone through your query and ultrasound results (attachment removed to protect patient identity). Did you pass out the stone before or after the ultrasound?
  • It is possible for the stone with the surrounding swelling that usually happens when the stone is at the VUJ to make it appear larger on the scan than the actual size.
  • A 3 mm stone not seen on the CT previously done means either an artifact or a new stone formed in the past month. If it is a stone, then it will have to pass down as well, though a 3 mm stone usually passes out without significant symptoms, it may cause pain as well.
  • The rest of the report is normal. If you are asymptomatic, then a followup ultrasound after three months would be advisable. In view of your repeated stone episodes, a complete urine blood tests for evaluation of possible factors contributing to the stone formation is also advisable.
  • Hope this helps, feel free to revert back with any questions.

For more information consult a urologist online --> https://www.icliniq.com/ask-a-doctor-online/urologist

Hello doctor,

I passed the stone five days after my ultrasound, so what he thought was 10 mm had to be the one I peed right? I brought my stone into the lab to be analyzed, do you still recommend urine tests? Many people are having success with a product because of the ingredient called "Chanca Piedra" within the product. Do you recommend I buy a bottle and do it for 30 days to clean myself out?

Dr. Karthik Rajan

Andrology Urology
#

Hi,

Welcome back to icliniq.com.

  • If the scan was before, then you have passed out the stone, the scan was fallacious in measuring the size.
  • The stone analysis will give an idea, but if it is a calcium stone then a full blood and urine workup is necessary in your case.
  • Regarding the herbal medication, research has not shown any action in clearing stones or preventing stone formation. So, I would not recommend it medically.

For more information consult a urologist online --> https://www.icliniq.com/ask-a-doctor-online/urologist

Thank you doctor,

A few more questions:

  1. Can you tell me what to ask my doctor for when asking for the blood/urine test?
  2. A question regarding this statement on ultrasound. "A small 3 mm echogenic foci was seen within the right kidney which may represent small renal stone." Do you know the percentages of this being an actual stone or just an artifact? Is it 50/50?

Dr. Karthik Rajan

Andrology Urology
#

Hello,

Welcome back to icliniq.com.

  • You can ask your urologist for a stone evaluation, he will have a set of investigations measuring your calcium, uric acid and other parameters in blood and urine.
  • Identifying a 3 mm stone depends on how confident the sonologist is and the resolution of the machine they use.
  • Since it is usually not very significant symptomatically, it is usually ignored and a follow-up examination is done after three months.

For further queries consult a urologist online --> https://www.icliniq.com/ask-a-doctor-online/urologist

Thank you doctor,

I have a friend who is a doctor and will order whatever I need. Do I just need to ask for a full "urine analysis" and get the results? When I get the results, can you read them and give me your recommendations? I am scheduling another ultrasound for three months from now. Do I want them to compare the 3 mm stone with what they find in the followup ultrasound?

Dr. Karthik Rajan

Andrology Urology
#

Hello,

Welcome back to icliniq.com.

  • You will need a blood analysis for calcium, phosphate and uric acid. A full routine urinalysis with a 24-hour urine analysis for calcium, sodium, phosphate, oxalate. You will also need to get the passed out stone analyzed for its chemical composition.
  • Yes, you can send me the reports and I can give you any recommendations, if necessary.
  • Yes, you will need to compare with the previous scan for the stone and also to identify whether any new stones have formed or not.

For more information consult a urologist online --> https://www.icliniq.com/ask-a-doctor-online/urologist

Okay, I got my results in for my kidney stone. They are below, can you tell me the type of diet I need to be on or send me a link that explains it? Also, any other information would be great. Thanks!

Calcium Oxalate Dihydrate (Weddellite) 95% Calcium Oxalate Monohydrate (Whewellite) 5%

Dr. Karthik Rajan

Andrology Urology
# Hi, You will need to reduce your salt intake, moderate calcium and reduce foods that are rich in oxalates such as green leafy vegetables, rhubarb, beets, tomatoes.

As always drink enough fluid to have an urine output of 2-2.5 litres. You may have to drink more in summer or if your job involves physical labour to achieve the same output of urine.
Ask a QueryAsk a Query Consult by PhoneConsult by Phone Video ChatVideo Chat
Also Read Answers From:

Related Questions & Answers


How to clear kidney stones?

Query: Hi doctor, I have a kidney stone in my right kidney and I have abdominal pain. Is there any medicine to clear out the stone or is the operation the only way? Please help me.  Read Full >>


Dr. Vivekanandan G
Urologist

Answer: Hi, Welcome to icliniq.com. I need to know the full details of your kidney stone like stone size, location, etc., to advise the treatment. So, please send full detail and the test report of your kidney stone disease. Revert back with full detail and test report to a urologist online --> https://...  Read Full

Popular

Popular

Ask your health query to a doctor online?

Ask a Doctor Now

* guaranteed answer within 4 hours.
Enter Your Health Query
You can upload files and images in the next step.

Fee: