What are Ureteric Stones?
Ureteric stones, also known as ureter stones or ureteral stones, are fundamentally kidney stones found in the ureters – the tubes that carry urine from the kidneys to the bladder.
Kidney stones are clumps of crystals that usually develop in the kidneys. But these clusters can form and advance anywhere along the urinary tract, which includes the bladder, urethra, and ureters. A ureter stone is a kidney stone inside one of the ureters, which are the tubes that connect the kidneys to the bladder. The stone will have formed in the kidney and passed into the ureter with the urine from one of the kidneys.
Causes of Ureteric Stones
A ureteric stone is formed due to high levels of uric acid, minerals, and oxalates in the urine formed in the kidneys. The stone moves down the ureter and gets stuck at one point, blocking the flow of urine. Insufficient water intake, obesity, the presence of urinary tract infections, and a family history of kidney stones increase your risk of developing a ureteral stone.
Signs and Symptoms of Ureteric Stones
If you have tiny uretic stones, they may pass through your urinary system on their own without any symptoms. Nonetheless, stones that obstruct the ureters or any of the kidneys’ drainage tubes may bring about symptoms that include:
- Difficulty urinating
- Pain or burning sensation while urinating
- Pain in your lower abdomen or flank (area of your back just under your ribs)
- Frequent urge to urinate
- Blood in the urine
- Nausea
- Vomiting
- Fever
Diagnosis of Ureteric Stones
To diagnose ureteric stones, your physician will review your symptoms and medical history and perform a physical examination. Your physician will also order certain tests to confirm the presence of ureteral stones. These include:
- Urinalysis: A urinalysis will check for signs of infection and examine levels of substances such as uric acid, calcium, and oxalate in your urine that cause ureteric stones.
- Blood test: A blood test will indicate how well your kidneys are working, look for infection, and check for other issues that may cause ureteric stones.
- Ultrasound: An ultrasound makes use of high-frequency sound waves to check for blockages in your ureters.
- Computed Tomography (CT) scan: A CT scan can assist your physician to determine the size, hardness, and location of the ureteric stones.
Treatment of Ureteric Stones
Treatment for ureteric stones depends upon the location and size of the stones. For smaller stones, your physician may recommend drinking high volumes of water to allow the stones to pass through on their own. However, if you have larger stones that are not likely to be passed, your physician may recommend one of these procedures:
- Nephrostomy Tube Placement: This procedure helps to temporarily relieve pain and is performed by an interventional radiologist. It involves the placement of a tube directly into the kidney through the back utilising only sedation and a combination of ultrasound and X-ray. This procedure is commonly utilised if an infection or fever occurs with urinary obstruction from a stone.
- Ureteral Stent Placement: This surgical procedure is performed under general anaesthesia and involves the placement of a small, soft, plastic tube into the ureter around the stone, enabling urine to bypass the stone. This is a low-risk procedure but needs to be followed up by another procedure to break up or remove the stone.
- Shock Wave Lithotripsy: This procedure utilises focused shock waves to disperse the stones into smaller fragments, which can then pass through your urinary tract and out of your body without additional assistance.
- Ureteroscopy: This is a procedure in which your urologist will pass a thin tube with scope into the urethra and up into the ureter. Once your physician can view the stone, it can be removed directly or broken up with a laser into smaller fragments that can pass on their own. This procedure may be preceded by ureteral stent placement to enable the ureter to passively widen over a few weeks prior to ureteroscopy.
- Percutaneous Nephrolithotomy: This procedure is usually employed if you have an abnormally shaped or very large stone in the kidney. Your physician will make a small surgical cut in your back and remove the stone through the surgical cut with a nephroscope. Even though this is a minimally invasive procedure, you will still require general anaesthesia.
- Medical Expulsive Therapy (MET): This kind of therapy involves using alpha-blocker drugs to aid in stone passing. However, according to a 2018 review of studies, there is a risk-benefit ratio to consider. Alpha-blockers aid in lowering blood pressure, which can be effective for removing smaller stones, but it also carries a risk of negative incidents.
