From the Guidelines
The typical duration for passing a ureteral stone can range from a few days to several weeks, with small stones less than 4mm often passing spontaneously within 1-2 weeks, while stones 5-10mm may take longer or require medical intervention. The likelihood of spontaneous stone passage correlates with stone size and location, as noted in the 2016 American Urological Association/Endourological Society guideline, part II 1.
Factors Influencing Stone Passage
- Stone size: Stones less than 4mm have a higher chance of passing spontaneously within 1-2 weeks, while stones 5-10mm may take longer or require medical intervention 1.
- Stone location: Stones located lower in the ureter pass more quickly, as the ureter naturally narrows as it approaches the bladder.
- Medical therapy: Alpha-blockers like tamsulosin (0.4mg daily) can help by relaxing the ureter muscles, potentially speeding passage and reducing pain medication needs 1.
Management and Treatment
- Pain management: Medications like ibuprofen (600-800mg every 6-8 hours) or prescription pain relievers such as ketorolac or narcotic medications may be recommended for pain management during the waiting period.
- Medical expulsive therapy (MET): Alpha-blockers can be used to facilitate stone passage, with a potential increase in stone-passage rates 1.
- Drinking plenty of fluids: 2-3 liters daily is crucial to help flush the stone.
- Surgical intervention: If a stone hasn't passed within 4-6 weeks, is larger than 10mm, causes severe pain uncontrolled by medication, leads to infection, or blocks urine flow, medical procedures like ureteroscopy, shock wave lithotripsy, or percutaneous nephrolithotomy may be necessary, with ureteroscopy recommended as first-line therapy for patients with mid or distal ureteral stones who require intervention 1.
Key Recommendations
- Patients with uncomplicated ureteral stones ≤10 mm should be offered observation, and those with distal stones of similar size should be offered MET with alpha-blockers 1.
- Clinicians should inform patients that SWL is the procedure with the least morbidity and lowest complication rate, but URS has a greater stone-free rate in a single procedure 1.
- URS is recommended for patients with suspected cystine or uric acid ureteral stones, and routine stenting should not be performed in patients undergoing SWL 1.
From the Research
Typical Duration for Passing a Ureteral Stone
The typical duration for passing a ureteral stone can vary depending on several factors, including the size and location of the stone.
- According to a study published in the Journal of Endourology 2, the average time to stone expulsion was about 17 days, with a range of 6-29 days.
- Another study published in The Journal of Urology 3 found that the time to stone passage varied depending on the size of the stone, with smaller stones passing more quickly.
- The study reported that for 95% of stones to pass, it took 31 days for those 2 mm or less, 40 days for those 2-4 mm, and 39 days for those 4-6 mm.
Factors Affecting Stone Passage
Several factors can affect the likelihood and duration of stone passage, including:
- Stone size: Smaller stones are more likely to pass spontaneously and more quickly 2, 3, 4, 5.
- Stone location: Stones located in the distal ureter are more likely to pass spontaneously than those located in the upper or mid-ureter 2, 3, 5.
- Stone width: The width of the stone is a significant predictor of spontaneous passage, with narrower stones passing more easily 4.
Predicting Stone Passage
Several studies have developed predictive models to estimate the likelihood of spontaneous stone passage based on factors such as stone size and location.
- A study published in European Radiology 4 found that stone size and location could be used to predict the chance of spontaneous passage with high accuracy.
- Another study published in Urolithiasis 5 found that stone diameter and stent duration were independent predictors of stone passage in patients with an indwelling ureteral stent.