From the Guidelines
Treatment for a 7 mm kidney stone should prioritize medical expulsive therapy (MET) as the first approach, with alpha-blockers like tamsulosin (0.4 mg daily) for 4-6 weeks to relax ureter muscles and facilitate stone passage, as recommended by the most recent guidelines 1.
Medical Expulsive Therapy (MET)
- Alpha-blockers like tamsulosin (0.4 mg daily) are recommended for 4-6 weeks to relax ureter muscles and facilitate stone passage.
- Pain management with NSAIDs such as ibuprofen (400-600 mg every 6 hours) or prescription pain medications may be necessary.
- Increased fluid intake of 2-3 liters daily helps push the stone through the urinary tract.
Procedural Interventions
- If the stone doesn't pass within 4-6 weeks, causes severe pain, creates a blockage, or leads to infection, procedural interventions like extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy with laser lithotripsy may be required.
- These procedures break the stone into smaller fragments for easier passage.
- A 7 mm stone is in a borderline size range where spontaneous passage is possible but not guaranteed - stones larger than 5 mm have a lower chance of passing naturally.
Monitoring and Follow-up
- During treatment, watch for warning signs like severe pain, fever, vomiting, or inability to urinate, which require immediate medical attention.
- Follow-up is mandatory to assess the stone's passage and adjust treatment as needed, as recommended by the EAU guidelines 1.
- The SIU/ICUD guidelines suggest that intervention should be done for stones greater than 7 mm, but the AUA guidelines recommend a maximal duration of conservative treatment of 4 to 6 weeks from the initial clinical presentation 1.
Ureteroscopy and SWL
- Ureteroscopy is a highly successful treatment option for ureteral stones, with high stone-free rates and low complication rates, as reported in the 2007 guideline for the management of ureteral calculi 1.
- SWL is also an effective treatment option, but its success rates may vary depending on stone size and location, as noted in the 2005 chapter on AUA guideline on management of staghorn calculi 1.
From the Research
Treatment Options for 7 mm Kidney Stone
- Extracorporeal shock wave lithotripsy (ESWL) is a common treatment for kidney stones, including those that are 7 mm in size 2, 3, 4, 5.
- Medical expulsion therapy (MET) using alpha-blockers, such as tamsulosin, can be used as an adjunctive treatment to improve stone passage rates after ESWL 2, 6, 4, 5.
- Alpha-blockers have been shown to increase stone clearance rates and reduce the need for analgesia during stone passage 2, 6, 4.
- The efficacy of alpha-blockers may vary depending on stone size, with some studies suggesting that they are more effective for stones 10-20 mm in diameter 6, 4.
- Tamsulosin, in particular, has been studied as an adjuvant treatment after ESWL, with some studies showing improved stone-free rates and reduced pain 4, 5.
Specific Studies
- A study published in 2011 found that alfuzosin, an alpha-blocker, increased stone clearance rates and reduced the need for analgesia after ESWL for renal stones 2.
- A study published in 2007 found that nifedipine and tamsulosin, both associated with ketoprofene, improved stone-free rates after ESWL for ureteral stones 3.
- A review published in 2018 found that alpha-blockers, including tamsulosin, were beneficial for ureteral stones ≤10 mm treated without lithotripsy, and for renal or ureteral stones >10 mm treated with lithotripsy 6.
- A study published in 2022 found that adjuvant tamsulosin did not increase the stone-free rate after ESWL for renal stones 5-20 mm in diameter, but may be beneficial for stones 11-20 mm in diameter 5.