A stone impacted in the urethra usually needs at least three days to pass spontaneously. If it cannot move, fragmentation is required; the exact clearance time varies from person to person.
The urethra has three natural narrow points. A stone that is too large becomes impacted, causing obstruction and local inflammatory edema. Copious fluid intake is encouraged to drive the calculus downward. Once the stone starts to migrate, complete expulsion usually occurs within about 72 h.
For stones that fail to move:
- Extracorporeal shock-wave lithotripsy (ESWL) is performed; afterward, most fragments pass with increased hydration.
- If ESWL is unsuccessful, holmium-laser lithotripsy is used.
- Post-fragmentation antibiotics are given to resolve inflammation and edema; clearance may be the same day or, after a second session, may require up to one week.
Patients must remain vigilant: prolonged obstruction can lead to hydronephrosis and even permanent renal impairment. During the episode, maintain a light diet and drink plenty of water.
| Stage / Measure | Key Facts | Time-frame & Tips |
|---|---|---|
| Spontaneous passage | Large stone impacted at one of 3 urethral strictures → obstruction + edema. | ≥ 3 days of increased fluid intake; once it moves, usually full expulsion within ~72 h. |
| Extracorporeal shock-wave lithotripsy (ESWL) | First-line when stone fails to move; most fragments pass with hydration. | Same day to 48 h for gravel clearance; may need second session. |
| Holmium-laser lithotripsy | Used if ESWL unsuccessful; fragments dusted or basket-extracted. | 1–7 days depending on stone load and session number. |
| Supportive care | Antibiotics for inflammation/edema; strict monitoring. | Prevents infection; helps fragments pass. |
| Red-flag warning | Prolonged blockage → hydronephrosis → renal function loss. | Maintain light diet, copious water; seek medical help if pain, fever, or anuria. |