0.6 cm – 0.8 cm UPJ Kidney Stones: Urgent Treatment for Kidney Stone Pain in NYC
Dr. Alex Shteynshlyuger is a board certified urologist in NYC who specializes in treating men and women with kidney stones and ureteral stones.
Treatment of Medium Sized 6mm-8 Mm UPJ Stones:
The UPJ (the junction of the kidney and the ureter) is the second narrowest point in the urinary system after the uretero-vesical junction (UVJ). UPJ stones that are 5-8 mm in size are the most common size of stone that cause pain at the UPJ.
Pain from a UPJ stone can be intermittent and can come and go. Pain may disappear for hours or sometimes for days at a time.
Stones that are bigger than 5 mm in size and get stuck at the UPJ as they travel down to the bladder do not always pass spontaneously. Even if a 5-8 mm stone were to pass through the UPJ, it may get stuck further down at the UVJ (uretero-vesical junction where ureter empties into the urinary bladder) which is even narrower than the UPJ.
Observation is reasonable if the patient has no infection, the pain is well controlled, and there is no significant nausea nor vomiting. If patient is comfortable and kidney function is normal, the patient may try to pass the stone spontaneously for up to 1 month.
The larger the stone, the less likely it is to pass on its own. If symptoms are significant, treatment should be undertaken sooner rather than later.
If infection is present in a patient with a ureteral or UPJ stone, stent insertion is needed urgently to relieve the obstruction and treat the infection with antibiotics.
While some patients are able to pass a 7mm-8 mm UPJ stone spontaneously, a significant number of patients require a surgical intervention such as ESWL lithotripsy or ureteroscopy with laser. Overall, the chances of passing 6mm-8mm UPJ stone is around 50%.
How Long Can You Wait to Pass a UPJ Stone?
If a patient does not pass the stone spontaneously in 30 days, then surgical treatment with ESWL or ureteroscopy is mandatory because long-term obstruction can damage the kidney. Typically, urologists may allow a patient to wait up to a month to pass the stone from the onset of symptoms as long as there are no signs of infection, pain is well controlled and kidney function is preserved.
If patient does not pass the stone within a month, then patient will be scheduled for a procedure to break the stone within 1-2 weeks (certainly before 6-8 weeks of observation).
If a patient develops severe pain or signs of infection, then urgent surgical intervention is mandatory. This is true for any obstructing stone in the ureter, at UPJ or at the UVJ.
If pain is significant and no infection is present, it is possible to insert a stent and do ureteroscopy (look inside the ureter) with laser (to break the stone) in one sitting.
If the ureter is too narrow, a stent is left in place for 1-2 weeks. The urologist then brings the patient back to the operating room once the stent has successfully dilated (opened up) the ureter passively. This allows the urologist to go up the ureter with the ureteroscope and use laser to break up the stone.
ESWL is the preferred intervention if the stone is at the UPJ and is radio-opaque (visible on KUB plain abdominal x-ray). The success rate of ESWL for UPJ stones is slightly lower than with ureteroscopy with laser. Sometimes more than one ESWL procedure is necessary.
For patients with multiple stones, laser lithotripsy may allow treatment of multiple stones in one sitting.
Surgical intervention (both ESWL and ureteroscopy) for a UPJ stone can be performed safely in patients with other medical problems such as lung disease, heart problems, diabetes, and high blood pressure.
The success of ESWL is around 80% for UPJ stones up to 8 mm in size. The success rate of ureteroscopy is 90-95% for 5-8 mm UPJ stones. A small number of patients will require more than one procedure to break the stone, but overall, close to 90% of the time, patients require only one procedure.
Dr. Alex Shteynshlyuger is a board certified urologist in NYC who specializes in treating men and women with kidney stones and ureteral stones. He has treated hundreds of men and women with large kidney stones.