<s>[INST] hi, I have kidney stones. Had a CT that showed 4 stones in left kidney that measure 0.7 x0.3 cm and a single faint stone in right kidney measuring 0.2 cm. I have had numerous stones, have never been able to pass any of them on my own. Have had a 24 hour urine and stone analysis that showed calcium oxalate and really try to do the diet recommended. I continue to form stones...the last one about 1 year ago requiring basket extraction. Is this size stone passable without intervention. I have had lithotripsey 2 -3 times and my old urologist said I could no longer do it as there is a risk of shock injury to my pancreas and potential for developing diabetes??? Is this true.? I have a new Dr (because other retired) and he wants to do litho. What are my options? Also, my pain is intermittent at times and at other times is constant and is located right at my Left kidney region. Do you only experience pain when it is in the ureters. Does the kidney itself have pain nerve endings? Can these pass or what is the size stone that is to large to pass. [/INST] HelloThnks for query. You are known to get recurrence of urinary stones mostly due to metabolic disorder. Now you have four stones in Left kidney bigger one of the size of 7 mm. Normally stone up to size of 8 mm can be expected to pass out spontaneously.However, there are multiple factors that govern the passage of stone out 1) Shape of the stone 2) Diameter of mouth of calyx. The pain occurs even when the stone is in kidney and occurs when it gets impacted at the mouth of calyx causing distention of calyx due to accumulation of urine in calyx. As regards no of lithography that one can be subjected to I would say that due to advanced technology and modern lithography machines one can have ESL for plenty of times and there is no danger to pancreas or any other organ. Since you have stone of a size of 7 mm and less you can expect them to pass out spontaneously. If they fail to pass down within a month you can go ahead for ESL. Chat Doctor.  </s>