Ureter Stone Treatment: How to Remove a Stone that Has Fallen into the Urinary Tract?

A sudden, stabbing pain in the side, nausea and cold sweats… If you are experiencing these symptoms, it is likely that a kidney stone has passed from your kidney and entered your urinary tract (ureter).

Ureter stones are very different from stones that remain silently in the kidney. Kidney stones are usually silent, but stones that fall into the ureter suddenly block the flow of urine, causing swelling in the kidney (hydronephrosis) and very severe pain (renal colic).

In this guide, we will examine in detail what treatment options you have to get rid of this painful process, which stones pass on their own, and the non-invasive surgical methods offered by modern medicine.

What is a Ureter Stone? (Anatomy and Formation)

The ureter is a thin, muscular tube approximately 25-30 cm long and only 3-4 mm wide that carries urine produced in the kidneys to the bladder (urinary bladder).

When a stone formed in the kidney breaks off and enters this narrow channel, it is called a ‘ureter stone’. The structure of the tube is narrow and has three natural constrictions. Stones usually get stuck at these constrictions:

  • The exit point from the kidney (UPJ).
  • The middle section where the main vessels pass over.
  • The entry point to the bladder (UVJ) – This is where stones most commonly get stuck.

Symptoms: How Do I Know If a Stone Has Fallen into the Duct?

The symptoms of a ureter stone vary depending on where the stone is located in the canal, but the most typical picture is as follows:

  • Severe Side Pain (Renal Colic): It usually starts in the back, spreads from below the ribs to the front, groin and genital area (to the testicles in men, to the labia in women). The pain comes and goes in waves.
  • Frequent Urination: As the stone approaches the bladder, it irritates it and creates a feeling of constantly needing to use the toilet.
  • Burning and Difficulty Urinating.
  • Haematuria: The colour of the urine is red, pink or tea-coloured.
  • Nausea and Vomiting: The severity of the pain affects the stomach.

Emergency Signal: If the pain is accompanied by a fever above 38 degrees and shivering, it means that a serious infection (pyelonephritis) associated with urinary tract obstruction has begun. You should seek emergency medical attention without delay.

Diagnosis: How is the Location and Size of the Stone Determined?

The treatment plan depends entirely on the size (mm) and location (upper, middle, lower ureter) of the stone.

  1. Ultrasound: Does not involve radiation but may not always show stones in the middle section of the ureter due to bowel gas. It shows swelling in the kidney (hydronephrosis).
  2. Drug-free Computed Tomography (CT): This is the gold standard. It shows the millimetric size of the stone, its hardness and exactly where it is blocking the canal with nearly 100% accuracy.
  3. Urine Test: The presence of infection and bleeding is checked.

Treatment Methods for Ureter Stones

Not every ureteral stone requires surgery. The treatment approach is stepwise:

A. Medical Treatment (Spontaneous Abortion)

If the stone is smaller than 5 mm and the patient has no fever, unbearable pain or loss of kidney function, your doctor may opt for a ‘wait and see’ approach.

  • Alpha Blockers (Medications): Also used in prostate treatment, these medications relax the urethral muscles, facilitating the passage of stones through the canal.
  • Plenty of Water and Movement: Drinking 3 litres of water per day and jumping/moving creates a gravitational effect.
  • Painkillers: To make the process more comfortable.

Duration: It usually takes 2-4 weeks. If the stone does not pass, intervention is performed to prevent damage to the kidney.

B. Ureteroscopy (URS) and Laser Lithotripsy

It is currently the most commonly used and most successful method for treating ureter stones. No incision is made; the procedure is performed entirely through the natural urinary tract.

How is it applied?

  1. The patient is put to sleep using general or regional (spinal) anaesthesia.
  2. The doctor inserts a very thin, lighted, camera-equipped instrument (ureteroscope) through the urethra.
  3. First, the bladder is entered, then the ureteral canal where the stone is located.
  4. It can be seen on the stone camera.
  5. The stones are broken down into sand-like particles using a holmium laser or thulium laser (lithotripsy).
  6. Large pieces are removed using a tool called a basket, while small grains of sand are passed in the urine.

Advantages:

  • There are no incisions or stitches on the body.
  • The success rate is between 95-99%.
  • The patient is discharged on the same day or the following day.
  • The return to normal life is very quick.

C. Flexible Ureteroscopy (RIRS)

If the stone is located very high up in the ureter, close to the kidney, or if it migrates into the kidney during the procedure, flexible soft endoscopes are used. These devices can be bent to reach inside the kidney and destroy the stone there using a laser.

D. ESWL (Extracorporeal Shock Wave Lithotripsy)

It may be preferred for upper ureter stones (those close to the kidney). However, its success rate is low for lower ureter stones, as the pelvis can block sound waves. Furthermore, when the stone is broken, pain (stone passage) may recur during the passage of the fragments. For this reason, URS (laser) is more commonly preferred for ureter stones.

What is a Stent (DJ Stent) and Why is it Inserted?

After ureter stone surgery, the topic patients are most curious about is the ‘Double-J (DJ) Stent’.

  • What is it? It is a thin plastic tube with both ends curved (shaped like the letter J). One end is placed in the kidney, and the other end is placed in the bladder.
  • Why is it inserted? After the stone is broken, the ureteral canal may become swollen. The stent is inserted to prevent this swelling from obstructing urine flow and causing pain again. It also allows any remaining grit to pass easily.
  • When is it removed? It is usually removed 1-2 weeks after surgery, in an outpatient setting, in a simple 1-minute procedure.
  • Can it be felt? It is not visible from the outside. However, the patient may feel a slight discomfort in the flank or an urge to urinate frequently. This is temporary and normal.

The Dangers of Ureter Stones: What Happens if Left Untreated?

Many patients fall into the misconception that ‘my pain has gone, the stone must have passed.’ However, sometimes when the stone completely blocks the ureter, the kidney slows down urine production and the pain subsides. This is called ‘silent death.’

  • Kidney Loss: If the blockage lasts longer than 4-6 weeks, the kidney tissue permanently thins and that kidney may lose its function and decay (atrophy).
  • Urosepsis: Infection of the blocked urine can lead to bacteria entering the bloodstream and causing a life-threatening condition known as sepsis.

Golden Rule: Even if your pain subsides, do not discontinue treatment unless you have seen the stone pass or your doctor has confirmed it via ultrasound.