So we were talking about kidney stones last lecture and I mentioned that size really matters in whether

a stone is going to pass spontaneously. Now, there's another factor that when you're talking about

kidney stones, ureterol, calcule, nephylothiasis, whatever you want to call it, and that's where the stone is. So if it's in the

proximal ureter, a proximal ureteral stone is actually less likely to pass spontaneously. Now that

may make sense, one because it's going to have a longer way to travel down the ureter.

The other thing to keep in mind is that the ureter actually tapers, meaning it gets narrower

as you go down the ureter.

So if it's not passing from a high point, you know, proximal to the kidney, that's not a good sign. So again, you want to keep

two major things in mind. What is the size of the stone? Where is it located? Because that's going to

tell you in your head, what are the real chances that this is going to pass? And that can be

important for both hospice and primary care doctors, meaning if I see a small

distal ureteral stone, and I'm really mostly worried about emitting the patient for pain control

because they're not septic and they're not getting hydronephrosis. And I look at it and it's like,

all right, this is pretty small, it's distal. I feel at it and it's like all right this is pretty small

it's distal I feel okay maybe I can just get this to pass and I don't really need a

urologist to get involved at least not immediately I can put the patient in do some

hydration analgesics alpha blockers all the things we're going to talk about.

Maybe I'll talk about hydration right now because that always comes up with a little bit of

controversy. So the controversy on that is should you just do regular maintenance fluids

or should you vigorously hydrate a patient when they have a kidney stone? Now, traditionally,

I think most people have used pretty high-rate IV fluids when you are dealing with a kidney

stone, and the thought process behind that seems reasonable. Meaning, you're thinking that

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