Most calculi will pass spontaneously (90%) and the golden rule is that stones ‹5mm will pass naturally. There is now quite strong evidence that previously normal kidneys can resist clinically significant damage from obstruction for up to 4 weeks and therefore it is reasonable to leave stones of ‹5mm for four weeks prior to considering intervention. The indications for treatment of ureteric stones are therefore
1) Uncontrollable pain
2) Renal impairment with single functioning renal units or bilateral stones
3) Stones larger than 5mm diameter
4) Stones that have been in-situ for up to 4 weeks
5) Recurrent urinary tract infections
This list is neither exhaustive nor absolute and often clinical situations will dictate different strategies tailored to individual patients.
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