Q: I am a 22 years old boy having pain in the left side of my back. The doctor advised an ultrasound in which a calculus of size 0.49 cm was found in the middle of the right kidney. In the left kidney, it revealed a dilated collecting system along with the ureter in its entire length. Two calculi of size 0.47 cm were seen at the left vesicoureteric junction and in addition two calculi of size 0.45 cm & 0.57 cm were seen at the lower and middle calyces. Now I have started treatment with homeopathic medicines and there is no pain for the last ten days. Is there any need for surgery? Is there any need for IVP test at this stage? What are the precautions required at this stage? Please advise.

A:You certainly require an evaluation by a urologist who would undertake additional imaging tests like CT scan to characterize the exact size, number, location of stones and degree of obstruction resulting form the stones. Further, due to the presence of enlargement/ swelling of parts of urinary tract (called hydronephrosis and hydroureter) resulting from the obstruction along with on and off symptoms of pain, you would require surgical removal of stones. Additionally, chemical analysis of the passed or removed stone and 24-hour urine studies to quantify amounts of excreted salts and minerals (like calcium. oxalate, citrate and uric acid) would help to diagnose the type and the cause of stone formation by you. On preventive front, you are advised to drink at least 2 litres of fluid/ day and be on a low salt diet to prevent recurrent stone formation.