3 mm. distal right ureteral calculus will not pass...

[doctora42]

Please, guide me on how to deal with a Kidney Stone Episode (last one -- 10 years ago -- stone passed spontaneously)

March 7: a sudden onset of an episode of excruciating pain on right side of abdomen, accompanied by nausea and vomiting and bloody (pink) urine.  Percodan + Zofran help.
March 8:  The severe pain disappears and has never come back.  (thought I passed the kidney stone.)  Internist finds blood in my urine (not visible to the naked eye).
March 10: An episode of painless gross hematuria.
march 11:  CAT Scan reveals  “ 3 mm. distal right ureteral calculus just proximal to the UVJ causing minimal fullness of the right ureter.”
Ever since:  new symptoms --  pressure in the lower abdomen (pelvis and groin) and right side of what feels like bottom part of urinary tract, more uncomfortable when I stand (gravity?), and a constant urge to urinate (I am drinking more than 2 liters of water daily to try flush the stone).  The pressure comes and goes, fluctuating in severity  (like in a urinary tract Infection), and is alleviated by sitting in a warm tub.  There is no pain in urination.  I use a strainer, and thus far – no stone.  Could the stone have passed?  If not, what should I do to expedite passage?

Please, guide…  

[David Rudnick, M.D.]

Hopefully you have passed it by now.  The urinary symptoms and groin pain you describe are classic for a stone right near the bladder.  Most 3mm UVJ stones pass without surgery, and Flomax and fluids are all you can do.  If it has not passed, the treatment of choice would probably be ureteroscopy, an endoscopic procedure to break up and remove the stone.

[Ninork]

A related discussion, Renal Calculi in UVJ was started.

[doctora42]

Discouraged.  Symptoms back -- intermittently:  pressure in lower abdomen (pelvis and groin) and right side of what feels like bottom part of urinary tract, plus the constant urge to urinate -- aggravated by aggressive fluid hydration.  Just read some studies concluding that aggressive fluid hydration during a kidney stone episode does not necessarily help reduce pain or improve the chances of successful stone passage.  What do you think?  Please, advise.  Thank you very much.

[doctora42]

Thank you, Dr. Rudnick, for taking the time to respond.  Your kindness is greatly appreciated!  The stone has not passed spontaneously as of yet (or, I have not seen it pass), though it is no longer causing symptoms. No UTI either.  I remain on Flomax and fluids, while trying to resume normal functioning (not allowing a 3 mm stone to take over…)  Two brief questions:
1. Could the stone have passed -- without me “catching” it -- despite the use of a strainer?
2.  I am scheduled to give a lecture abroad in mid-April and am told it is OK to go – whether or not the stone is out.  Do you approve?
Thank you again for your generosity!  You are providing an important service for which I am truly grateful.

[doctora42]

Forgot to add:  I am on Flomax 0.4 mg. for past 3 days.