6mm Stones

My name is Naveen Kachroo

and I’m a urologist who specialized in treating kidney

stones and also part of the kidney stone Collaborative

where our team is committed to helping you

through your journey with kidney stones.

We received many excellent questions from the worst pain

ever community, and one of the questions we received was,

how long should I wait for my six millimeter stone to pass?

Is there too long? Uh, and does Flomax really help?

Um, these are really good questions

and we know that dealing with passing a kidney stone can be

quite challenging, not just from the horrible pain

and symptoms you’re experiencing,

but from not knowing what to expect

and how long this process is gonna go on for.

So I’ll try to break this down into three parts.

Uh, the first part is, uh, what are my chances

of passing a six millimeter stone?

So, uh, this is considered on the largest

side of stones for natural passage.

As stones sort of four millimeters

or less have a sort of almost 80% chance

of passing on their own

and stones around six millimeters have a 50 to 60% chance

of passing on their own, dependent upon where it is in

that drainage tube from the kidney called the ureter.

If the stone is in the kidney, it may very happily sit there

for many years and may never come out, but it,

or it may even pop out tomorrow.

But if it is in the ureter,

there are generally three places in its journey down

that tube where it may get stuck.

The first is the ureteral pelvic junction, which is the spot

where the, the ureter leaves the kidney.

The second part is the spot just over sort of midway, uh,

down where the ureter crosses over some big vessels

called the iliac vessels.

Um, and then at the point where the ureter sort

of nearing the bladder in the distal ureter

or ureter val Sical junction

or UVJ, generally your chance of passage increases

as it further travels down that ureter with sort

of less than 50% chance when it’s in the proximal ureter,

about 60% chance when it’s in the mid ureter

and over 70% once it gets down into

that lower distal ureter.

How long does this process take?

This can sort of vary depending upon the, the location, um,

especially where the six millimeter stone is, um,

as those which are higher up may take longer,

but on average, we are finding that it takes about four

to six weeks to pass a stone like this.

If the stone hasn’t passed at that six week mark,

this is the point that I would say would be classified

as being too long to allow the stone to just remain there.

Um, and you may need a CT scan

to assess whether it’s still there.

Um, if you’re not experiencing any symptoms, um,

or whether you may need a procedure in order

to remove the stone at that point, your ability to wait

that long will often depend upon how bad your pain is.

Do you have signs of infection?

Uh, are you getting bad symptoms of nausea, fevers, um,

or if there’s any concerns about whether

that stone is blocking the kidney

and causing any sort of damage to your kidney.

If you are experiencing unbearable pain, fever,

persistent nausea, or have any concerns, it is crucial

that you seek medical attention at that point

and not try to wait it out.

The other part of the question was, was does flomax

that medication help you

and I, I would say yes, Flomax can help.

It is a medication, uh, which is called a, an alpha blocker,

and this is really designed to relax the muscles

of the ureter to help the stone pass.

Studies have shown that it can increase the chance

of passing stones, especially those in the lower part

of the ureter, uh,

and for stones that are less than 10 millimeters.

But it is not a guarantee

that it will allow that stone to pass.

Not all experts feel that it is worthwhile

and there is some sort of controversy in the literature.

I personally like to use it.

I think it does help with stone passage.

I think it helps with some of your pain control

and it can also help if you are planning a stone removal

procedure if we are to sort of go up

that drainage tube to treat the stone.

It is important to understand that, that

that medication does have some side effects, um, such

as effects on your blood pressure

so it can drop your blood pressure

and cause dizziness, um, among males.

It can affect ejaculation, uh,

whilst taking that medication.

And it’s also important that if you are due

to undergo cataract surgery, that, that you’re aware

that it may affect like the outcome of fat surgery.

Thanks.