Treatment Options for a 7 mm Stone in the Ureter.
Dr. Alex Shteynshlyuger is a board certified urologist in NYC who specializes in treating men and women with kidney stones and ureteral stones.
The Choice of Treatment for 6 mm to 7 mm Ureteral Stone Depends on a Variety of Clinical Factors:
1. Location of the stone in the proximal, mid or distal ureter
2. Patient’s symptoms, whether the pain is mild and tolerable or severe and requires immediate intervention.
3. Patient’s gender: ESWL lithotripsy is not a good option for distal ureteral stones in women of reproductive age.
4. Existence of other medical problems such as renal insufficiency, solitary kidney or immuno-compromise.
Distal Ureteral Stones Close to the Urinary Bladder
Some patients with ureteral stones, and in particular small ureteral stones can be managed with observation and medically expulsive therapy in an effort to pass the stones spontaneously.
Typically, for patients with minor symptoms and no evidence of infection or other contraindications to medically expulsive therapy who have a small stone (3 mm, 4 mm, 5 mm up to 7 mm) in the distal ureter, medically expulsive therapy is the preferred option. For those patients with infection, ureteral stenting is usually the preferred option. For patients with severe pain stenting with or without ureteroscopy may be the preferred option.
Ureteral stones can be treated using lithotripsy (ESWL) or laser. In the upper ureter, ESWL in an effective treatment option.
Because of the proximity of the ovaries to the ureter in the pelvis, ESWL lithotripsy cannot be used in in the lower ureter for women of childbearing age. For ureteral stones in the lower ureter in women of childbearing age, ureteroscopy provides an optimal treatment option.
Treatment of Mid-Ureteral Stones
Very small mid ureteral stones can pass spontaneously.
In general, mid-ureteral stones can be treated using lithotripsy (ESWL) or Holmium laser during ureteroscopy. While ureteroscopy tends to have higher success rate, ESWL is less invasive. The choice of treatment is usually individualized based on stone size, symptoms and patient preferences.
Treatment of Upper Ureteral Stones at UPJ
In the upper ureter both ureteroscopy and ESW Lithotripsy are effective treatment options.The choice between these options depends on patient’s characteristics, stone size as well as stone density (Hounsfield units). ESWL is typically the preferred initial approach for smaller stones for most patients.
Dr. Alex Shteynshlyuger is a board certified NYC urologist who specializes in treating men and women with kidney stones and ureteral stones.