QUESTION
"From midnight to 8 a.m. on July 18, 2010, I labored to pass a kidney stone.
Finally in the ER, the doctor used a CAT scan to determine that the kidney stone had passed out of the kidney and the connecting tube into the bladder. The CAT doctor estimated the stone to be 9 mm.
I was given a "strainer" and told to "watch" for the stone or pieces to pass "naturally" and the worst was over.
I watched for over a week and found not even a speck of that 9 mm stone.
My question is: Can that kidney stone dissolve or break up so small that I would not see it without the strainer? or does that 9 mm bullet stay in my bladder for the rest of my life? If so, does it pose a threat of any type?
I have no health insurance, so I didn't go to a urologist for the follow-up exam. I have no pain or problems at this time.
If that 9 mm stone tries to pass, will it damage my "small caliber barrel" or — even worse — get stuck in the "magazine"?
I am trying to keep smiling, but behind my mask of levity is a serious patient. I await your good prognosis. Thanks!
ANSWER
Six millimeters is the cutoff for passable stones; over 6 mm is difficult to pass from the kidney to the bladder via the ureter tube.
They can dissolve or fragment and pass without seeing them, but that is rare.
If it got from the kidney to the bladder it will pass, but it is almost certainly hung up in the ureter (can't wait on that as back pressure on the kidney is a bad thing) or in the kidney (not urgent to do shock wave treatment if still in the kidney, but it may grow and/or try to go down the ureter — passing down the ureter is where the pain occurs). The CAT scan cannot see stones in the bladder, so I am sure it is in her kidney. That will not cause damage, but will grow and eventually have to try to pass (difficult at that size) or be lithotripsied.
Monitor its size with X-ray if is calcified and shows up on X-ray. If not calcified, monitor size and location by sonogram.
