From the Guidelines
A 3mm ureterovesical junction (UVJ) kidney stone has a high likelihood of passing naturally without surgical intervention. You should increase your fluid intake to 2-3 liters of water daily to help flush the stone through your urinary system, as recommended by recent guidelines 1. For pain management, take over-the-counter medications like ibuprofen (400-600mg every 6-8 hours) or prescription pain medications if provided by your doctor. Alpha-blocker medications such as tamsulosin (0.4mg daily) may be prescribed to relax the ureter and facilitate stone passage, particularly for distal ureteral stones greater than 5 mm, according to EAU guidelines 1.
Key Considerations
- Strain your urine using a filter to catch the stone for analysis.
- Most 3mm stones pass within 1-2 weeks.
- Seek immediate medical attention if you develop severe pain uncontrolled by medication, fever, chills, nausea, vomiting, or inability to urinate. The stone's location at the UVJ means it has already traveled through most of the ureter and is at the final junction before entering the bladder, which is typically a narrow point where stones can get temporarily lodged. Once the stone passes into the bladder, symptoms usually improve dramatically, and the stone will likely exit during urination.
Treatment Options
- Conservative management is possible for uncomplicated ureteral stones, with a cutoff size for observation of 10 and 6 mm in AUA and EAU guidelines, respectively 1.
- URS is recommended as first-line treatment of distal ureteral stones greater than 10 mm, while SWL is an equivalent option for stones less than 10 mm, according to EAU and SIU/ICUD guidelines 1.
Monitoring and Follow-up
- Follow-up is mandatory if conservative management is chosen, with a maximal duration of conservative treatment of 4 to 6 weeks from the initial clinical presentation, as suggested by AUA guidelines 1.
From the Research
Treatment Options for 3mm UVJ Kidney Stone
- The size of the kidney stone is 3mm, which is considered small and may be treated with medical expulsive therapy (MET) 2, 3, 4, 5, 6.
- Alpha-blockers, such as tamsulosin, are commonly used as MET to facilitate stone passage and have been shown to be effective in increasing stone clearance rates 3, 4, 6.
- The use of alpha-blockers may also reduce the risk of colic events, narcotic use, and hospital visits 2.
- However, the effectiveness of alpha-blockers may vary depending on the size of the stone, with larger stones (>5mm) showing a greater benefit from treatment 4, 6.
Efficacy of Alpha-Blockers for Small Kidney Stones
- For stones ≤10 mm, alpha-blockers have been shown to increase clearance rates in most meta-analyses and one randomized controlled trial (RCT) versus control 3.
- A systematic review and meta-analysis of RCTs found that tamsulosin was associated with a higher stone expulsion rate, shorter stone expulsion time, and lesser incidence of ureteral colic for stones greater than 5 mm 6.
- However, for stones 5 mm or smaller, the benefit of alpha-blockers is less clear, with some studies suggesting no significant effect 4, 6.
Recommendations for Treatment
- For a 3mm UVJ kidney stone, conservative management with pain control and follow-up imaging may be recommended 5.
- Medical expulsive therapy with an alpha-blocker, such as tamsulosin, may be considered to facilitate stone passage, although the benefit for small stones is less clear 2, 3, 4, 5, 6.
- Patients should be screened for risk of stone recurrence and lifestyle modifications, such as increased fluid intake, should be recommended 5.