Conservative Treatment of a 6mm Prevesical Stone

Introduction to Conservative Treatment

The European Association of Urology (EAU) recommends conservative treatment for ureteral stones up to 6mm in size, as stated in the EAU guidelines 1, 2
The American Urological Association (AUA) guidelines suggest a maximum duration of conservative treatment of 4-6 weeks from the initial clinical presentation to avoid irreversible kidney damage 1, 4

Conservative treatment of uncomplicated ureteral stones is possible, with the EAU guidelines setting a threshold of 6mm for observation 1, 3
Regular follow-up is mandatory for conservative treatment 1, 2

Medical expulsive therapy (MET) with alpha-blockers is an option, particularly for distal ureteral stones larger than 5mm, as recommended by the European Urology guidelines 5, 6
Nonsteroidal anti-inflammatory drugs (NSAIDs; diclofenac, ibuprofen, metamizol) are the first-line treatment for renal colic 5, 6
Opioids are recommended as second-line analgesics when NSAIDs are contraindicated 6

Regular imaging follow-up is necessary to monitor stone passage and detect complications early 1, 7
Intervention should be considered if the stone has not passed after 4-6 weeks, or if complications such as infections, sepsis, or anuria occur 1, 4, 5, 6
Intervention is also recommended in cases of severe, uncontrolled pain or obstruction with kidney swelling 6, 7
In cases of sepsis and/or anuria with obstructed kidney, urgent decompression of the system via percutaneous nephrostomy or ureteral stenting is strongly recommended 6

Urine microscopy and culture results should be obtained before any stone treatment to exclude or treat urinary tract infections 6
Patients with bleeding disorders or those on antithrombotic therapy should be consulted with an internist for appropriate therapeutic measures 6