Waiting for a Stone to Pass: Does Medication Actually Help?

နောက်ဆုံး ပြင်ဆင်သည် ဩဂုတ် 22, 2026

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Most people with a small ureteric stone would rather wait for it to pass than have an operation, and most of the time that is a reasonable plan. The question that follows is whether a tablet can improve the odds. This is called ဆေးဘက်ဆိုင်ရာထုတ်ပယ်ခြင်းကုထုံး, and the honest answer has changed since this article was first written.

• ထိုင်းနိုင်ငံ ဆီးလမ်းကြောင်းဌာန ဘန်ကောက်ဆေးရုံ အွန်လိုင်းဘွတ်ကင်လုပ်ခြင်း။ 02-310-3009 bhquro@bdms.co.th
• Samitivej Sriracha ဆေးရုံ Chonburi 088-022-1445

First: Waiting Is Only an Option If It Is Safe to Wait

Nothing below applies if any of these are present. They mean the stone is dealt with now, not watched:

• Fever or chills with the pain — a blocked kidney that is also infected needs urgent drainage, and antibiotics alone will not do it
• Pain that painkillers do not control, or repeated attacks
• Vomiting that stops you keeping fluids or tablets down
• Both kidneys obstructed, a single kidney, a transplanted kidney, or deteriorating kidney function
• ကိုယ်ဝန်

Attend an emergency department, or call 1669 in Thailand. The symptom list is set out more fully in ureteric stone pain: what helps and what cannot wait.

How Likely Is It to Pass on Its Own?

Two things decide it: how big the stone is, and how far down it already is. Broadly, and these are approximate figures rather than promises:

• Stones under about 5 mm pass spontaneously in roughly two-thirds of people; stones between 5 and 10 mm in something closer to half
• A stone already in the lower ureter, near the bladder, passes far more often than one still high up near the kidney — roughly three-quarters against about half
• Above about 10 mm, spontaneous passage becomes unlikely and waiting mostly buys pain rather than time

A Correction: What the Tablet Really Does

An earlier version of this article stated that medical expulsive therapy increases the passage rate by about 29% and attributed that figure to US and European guidelines. That overstates it considerably, and it is corrected here.

Early studies were small and enthusiastic. Then two large, properly blinded, placebo-controlled randomised trials tested alpha blockers in this setting and found no overall benefit — people given the drug passed their stones no more often than people given a dummy tablet. Subsequent analysis pooling the evidence found the benefit is real but narrow: it appears in larger stones, above about 5 mm, sitting in the lower ureter, and it is hard to demonstrate at all in small stones — which is unsurprising, since most of those pass anyway.

That is why current guidance is phrased as may be offered for larger distal stones rather than as a routine addition for everyone. It is worth taking in the right situation, and it is not the difference between an operation and no operation in most people. It is also, in most countries, an off-label use of a drug licensed for the prostate — which is perfectly normal practice, but you are entitled to know it.

The Side Effects You Should Be Told About

Alpha blockers relax smooth muscle, which is how they help the ureter — and also why they do the following:

• Light-headedness or dizziness on standing, from a drop in blood pressure. Worst with the first few doses, which is why they are usually taken at night. Stand up slowly.
• Changes in ejaculation — reduced volume, or semen going backwards into the bladder rather than outwards. Men are frequently not warned about this and find it alarming. It is not dangerous and it reverses when the drug is stopped, but nobody should discover it by surprise.
• Interaction with erectile dysfunction tablets. Both lower blood pressure, and taken together they can drop it too far. Tell your doctor if you take one.
• Cataract surgery. Alpha blockers can cause intraoperative floppy iris syndrome, which makes cataract surgery more difficult. If you have ever taken one, tell your eye surgeon — even years later. This matters more than the dizziness and is almost never mentioned.
• Headache, blocked nose, and a temporary increase in pain as the stone starts moving.

Do not take these tablets on your own. Not because they are exotic, but because taking them means committing to a period of waiting — and waiting is only safe when someone is checking that the kidney is not quietly being damaged.

How Long Is It Safe to Keep Waiting?

This is the question the original article never answered, and it is the most important one. A trial of waiting is generally reviewed at around four to six weeks, with imaging — usually an ultrasound — to see whether the stone has moved and whether the kidney is still swollen. Beyond roughly that window, prolonged obstruction begins to risk permanent loss of function in that kidney, and the balance tips towards treating the stone.

And here is the trap that makes follow-up non-negotiable: the pain settling does not mean the stone has passed. A completely obstructed kidney often stops hurting, because the pressure stabilises. A man who feels better, never saw a stone come out, and quietly stops attending can lose that kidney over months without a single symptom. If you did not see the stone, you have not finished. Strain your urine, keep whatever appears, and keep the follow-up appointment either way.

If waiting does not work, the alternatives are shockwave treatment or ureteroscopy with the holmium laser — both set out on the ကျောက်ကပ်ကျောက် ကုသမှု page. Whatever happens, the stone that has just passed is the beginning of the next conversation rather than the end of this one: without prevention, the recurrence rate is high, and the habits that prevent stones are worth more than any tablet described here.

မေးလေ့ရှိသော မေးခွန်းများ

Does medication really help a ureteric stone pass?

Less than was once claimed. Early small studies were encouraging, but two large placebo-controlled randomised trials found no overall benefit from alpha blockers, and pooled analysis since suggests the benefit is confined to larger stones, above about 5 mm, sitting in the lower ureter. Current guidance therefore says it may be offered in that situation rather than routinely. It is a reasonable addition in the right patient, not the difference between surgery and no surgery for most people.

What are the chances my stone passes by itself?

Roughly two-thirds for stones under about 5 mm and around half for those between 5 and 10 mm, with position mattering as much as size: a stone already low in the ureter near the bladder passes far more often than one still high up. Above about 10 mm spontaneous passage is unlikely. These are approximate figures from the literature rather than individual predictions, and the CT measurements are what the estimate is actually based on.

What side effects do these tablets have?

Light-headedness on standing, particularly with the first doses, which is why they are usually taken at night; changes in ejaculation, including reduced volume or semen passing backwards into the bladder, which reverses on stopping; headache and blocked nose; and a temporary increase in pain as the stone moves. They also lower blood pressure alongside erectile dysfunction tablets, so tell your doctor if you take one. Importantly, they can cause floppy iris syndrome during cataract surgery, so tell your eye surgeon if you have ever taken one.

How long can I safely wait for a stone to pass?

A trial of waiting is usually reviewed at around four to six weeks with imaging. Beyond roughly that window, continued obstruction begins to risk permanent loss of function in that kidney and the balance shifts towards treating the stone. Waiting is a monitored plan with a review date, not an open-ended hope.

My pain has stopped. Does that mean the stone passed?

Not necessarily, and this is the most dangerous assumption in the whole subject. A completely obstructed kidney frequently stops hurting once the pressure stabilises, so pain settling is not proof of anything. If you did not actually see a stone come out, the follow-up imaging still needs doing — a silently obstructed kidney can be lost over months without symptoms. Strain your urine and keep whatever appears, both as proof and for analysis.

When should waiting be abandoned?

Immediately, if fever or chills develop, if pain cannot be controlled or keeps returning, if vomiting prevents keeping fluids down, or if urine output falls. Also if follow-up shows the stone has not moved, the kidney remains obstructed, or kidney function is deteriorating. In those situations the options are shockwave treatment or ureteroscopy.

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Dr. Soarawee Weerasopone treats kidney and ureteric stones at ဘန်ကောက်ဆေးရုံ