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Is surgery necessary to remove kidney stones?

Q: My 63 years old father has a kidney stone of size 8 mm in the right kidney. This was diagnosed during some other test since there were no symptoms of pain or urine problem. Is the stone harmful and can it damage the kidney? The doctor recommended IVP test for a detailed examination. Please advise.

A:Based on the information, it seems that your father is noted to have kidney stone detected incidentally, possibly forming it for the first time. Next step should be CT scan without contrast (stone protocol), a special technique of imaging stones of the kidneys and the ureters to exactly localise and characterise the stone while also looking for any other small stones. Intravenous pyelogram is needed to study the abnormalities in the anatomy of the urinary tract predisposing towards stone formation. Further, he is advised to drink at least 2 litters of fluid on a daily basis intended to help in the spontaneous passage of the formed stone. Unfortunately, most stones of sizes > 5 mm doesn’t spontaneously pass and if are noted to cause any symptoms of pain or discomfort, then they would need surgical intervention. Lastly, he could benefit from further evaluation even though he has formed the stone only the first time. He would need 24-hour urine studies for quantification of various mineral/salts and also if possible chemical analysis of the passed/removed stone. This would help to know the type of stone and accordingly guide the specific medical therapy, which does help to prevent future stone formation. This all can be done in close consultation with an urologist.

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