### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hi. After a non-contrast CT scan, Ive been diagnosed with multiple non-obstructing renal calculi. In the right kidney, there are at least 5 calculi with the largest measuring 3mm. In the left kidney, there are also at least approximately 5 calculi with the largest measuring 5mm. No uretic calculus is detected and there is no hydroureter or hydronephrosis.I had a recent X-ray which did not show any kidney stones on the right side, which was why the urologist ordered the recent CT scan. I was on a waiting list to have ESWL. Do you think it will still be necessary?

### output:

Hi, The treatment of kidney stone depends on your symptoms, size and location. Asymptomatic calculi, less than or equal to 5 mm can usually be managed by medical therapy (e.g. potassium citrate syrup, Eurostat, thiamine etc.).  ESL is good for a single stone between size 5 to 10 mm. Since shockwaves have to pass through the kidney to break the stones, there is a limit to the number of shockwaves that a kidney can tolerate. Moreover, small stones are difficult to localize in fluoroscopy or ultrasound during ESL. Thus, ESL is a very poor choice for multiple small stones.  For multiple small stones, current treatment of choice is flexible ureteroscopy with laser. In this procedure, the surgeon can see inside the kidney and treat each and every stone with laser. Thus, clearance rates are very good. However, its availability is limited to a few centers.  In your case, if you do not have any symptoms, I advise you to start medical therapy after undergoing a 24-hour urine metabolic work up (Check urine volume, pH, creatinine, calcium, phosphorus, sodium, uric acid, oxalate, citrate and magnesium) along with serum creatinine, calcium, uric acid and electrolytes. These tests will help to find out the reason for formation of kidney stones. Accordingly, individualized medical therapy can be advised to dissolve current stones and prevent future stones.  General measures to treat kidney stones are to keep urine output more than 2.5 liters per day, reduce salt intake less than 5 g/day and reduce animal protein intake.  I hope I have answered your query. If you need any clarification, please feel free to contact me. Wish you good health, Warm regards,