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Is surgery necessary for a stone in the ureter?

Q: My 63 years old father is having a 5 mm stone in his right ureter. However, there is no pain. The doctor suggested the following tests - NCCT-KUB, ultrasound KUB, x-ray KUB, IVP and urine culture. The reports confirmed the presence of pus cells in the urine and stone. The doctor recommended ureteroscopic lithotripsy (UR) surgery for him. What should we do? There is a little dilation in the right ureter while both the kidneys are functioning properly. Please advise.

A:The natural history shows that 90% of ureteric stones smaller than 5 mm would pass out spontaneously. You may give credit to nature, or the treatment you had taken the previous day, when it passes out. Statistics shows that 90% of those stones that pass out do so within 3 weeks. There is added evidence that kidneys remaining obstructed due to a stone for more than 3 to 4 weeks time may suffer irreversible damage. Usual indications for intervention like URS for ureteric stones smaller than 5 mm, thus, are ureteric stone in a solitary kidney unit, severe repeated colics, fever with chills (signifying associated infection, which is an emergency) and non-passage of a ureteric stone in 3 to 4 weeks time.

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