From the Guidelines
Ureteroscopy with laser lithotripsy is the recommended first-line treatment for a 7mm stone at the vesicoureteric junction (VUJ) due to its high stone-free rates and low complication rates. The management of a 7mm stone at the VUJ typically requires active intervention rather than observation. According to the 2007 guideline for the management of ureteral calculi 1, ureteroscopy has evolved into a safer and more efficacious modality for treatment of stones in all locations in the ureter, with overall stone-free rates remarkably high at 81% to 94% depending on stone location.
Key Considerations
- The stone size of 7mm has a low probability of spontaneous passage, and prolonged obstruction can lead to kidney damage, infection, or sepsis if left untreated.
- Ureteroscopy with laser lithotripsy has been shown to be highly successful in treating stones in the distal ureter, with an overall stone-free rate of 94% achieved with either a rigid or semirigid ureteroscope 1.
- While extracorporeal shock wave lithotripsy (ESWL) is an alternative option, it may be less effective for stones at this location.
- Medical expulsive therapy with tamsulosin 0.4mg daily can be prescribed to relax the ureter and potentially facilitate stone passage, though success rates for stones this size are limited.
- Pain management should include NSAIDs such as ibuprofen 400-600mg every 6-8 hours or ketorolac 10mg every 6 hours, with opioids like hydrocodone/acetaminophen 5/325mg every 4-6 hours reserved for breakthrough pain.
Additional Recommendations
- Adequate hydration of 2-3 liters of water daily is essential to help facilitate stone passage and reduce the risk of complications.
- Patients should strain their urine to collect any passed stone fragments for analysis.
- Follow-up imaging with a CT scan or ultrasound is necessary to confirm complete stone clearance.
From the Research
Management of a 7mm Stone at the Vesicoureteric Junction (VUJ)
- The management of a 7mm stone at the VUJ can be complex and may require a combination of medical and surgical interventions 2, 3.
- Alpha-blockers, such as tamsulosin, may be used to facilitate the passage of the stone by relaxing the muscles in the ureter 4, 5, 6.
- Studies have shown that alpha-blockers can improve stone clearance rates, reduce the need for auxiliary treatments, and decrease the likelihood of major adverse events 5, 6.
- However, the effectiveness of alpha-blockers may vary depending on the size and location of the stone, as well as the individual patient's anatomy 5, 6.
- In some cases, ureteroscopy and laser fragmentation may be necessary to remove the stone, especially if it is large or impacted 3.
- The use of contrast CT scans can help to identify the anatomy of the kidney and collecting systems, which is important for determining the best course of treatment 3.
- The management of a 7mm stone at the VUJ should be individualized and based on the specific needs and circumstances of the patient 2, 4, 5, 3, 6.