Ureteral Stones

A ureteral stone is a kidney stone that’s stuck in one of your ureters (“yer-it-ters”). These are the muscle tubes that connect your kidneys to your urinary bladder. Ureters can be 10 to 12 inches long, depending on your height. Most of us have one ureter for each kidney.

A ureteral (“yer-ree-ter-uhl”) stone or calculus is an irregularly shaped solid mass of crystals, minerals and salts that build up in your pee. Some stones can block the flow of pee and cause severe pain.

Stones may show up near the end of the ureter that connects to your renal pelvis. There’s a renal pelvis in the center of each of your kidneys, and it collects pee. Stones may also be in the middle or end of the ureter that connects to your bladder.

Ureteral stones can vary in size. When they’re tiny (too small to see with the naked eye), they pass through your pee and don’t cause any problems. The larger the stones, the lower the chance of them passing on their own, and the greater the chance you’ll have symptoms.

Urinary stones are common. They affect about 1 in 10 people in the world.

Types of ureteral stones

The main types of stones include:

• Calcium stones: These are the most common type of ureteral calculus. Types of calcium stones include calcium oxalate stones and calcium phosphate stones.
• Uric acid stones: Uric acid stones form when there’s too much uric acid in your pee.
• Struvite stones: Struvite stones sometimes form after you’ve had a urinary tract infection (UTI). Magnesium ammonium phosphate (struvite) and calcium carbon-apatite make up most of a struvite stone.
• Cystine stones: The genetic disorder cystinuria (“sis-tah-nuhr-ee-ah”) causes cystine stones. Cystinuria makes the amino acid cystine leak out of your kidneys and into your pee.

Symptoms of a ureteral stone

Tiny ureteral calculi may pass through your urinary system on their own without any symptoms. But stones that block your ureters or any of your kidneys’ drainage tubes may cause problems.

Symptoms of a ureteral calculus include:

• Severe pain that comes and goes in your back or side (under your lower ribs)
• Pain that spreads (radiates) to your lower belly
• Pain or a burning feeling while peeing
• Nausea and vomiting
• Bloody or discolored pee (brown, pink or red)
• Cloudy pee
• Frequent urges to pee
• Only a small amount of pee when you go

You also may have a fever, chills or an unwell feeling when you have a urinary tract infection along with the passage of stones.

Ureteral stone causes

Stones form when there’s too much of a stone-forming substance (crystals) in a small amount of your pee. When you drink enough water, the substances that make up ureteral stones usually become diluted and less likely to make stones.

Risk factors

Anyone can develop a ureteral stone. But you’re more likely to get a ureteral calculus if you:

• Are male (but females and children get them, too)
• Are white
• Are between the ages of 40 and 60
• Have had kidney stones before
• Have a biological family history of stones
• Aren’t making a good amount of pee, which depends on how much water you drink and how much water you lose through sweat and medical issues
• Have Type 2 diabetes
• Have a BMI (body mass index) above 30
• Have conditions that cause diarrhea, like Crohn’s disease or ulcerative colitis
• Have polycystic kidney disease

How to lower your risk

You may be able to lower your risk of kidney stones by managing conditions that raise your risk of stones. Another way to lower your risk is to make sure you’re drinking enough water. Your pee should look pale yellow if you’re getting enough fluids. You can change what you eat to lower the amount of crystals that may contribute to kidney stones in your urine. Also, a series of tests called a metabolic workup for kidney stones can help pinpoint the problem. It can provide guidance on improved stone prevention, as well.

Complications of this condition

You’re more likely to have complications if you don’t seek treatment for ureteral stones. Untreated stones can grow larger. A ureteral calculus can block the passage of pee through your ureter and cause pain. It may also increase your risk of an infection. A blockage can make your kidney swell from the backup of pee, too. Without treatment, this can harm your kidney.

How doctors diagnose a ureteral stone

A healthcare provider will ask about your symptoms, previous history of kidney stones and other medical issues. They’ll perform a physical exam. They’ll also order tests to confirm that you have ureterolithiasis.

Tests to diagnose ureteral stones include:

• Urinalysis: This test will look for signs of infection and measure the amount of substances in your pee that cause ureteral stones. If your provider suspects an infection, they can order a urine culture.
• Blood test: This test will reveal how well your kidneys are working, check for infection and look for other problems that may cause ureteral stones.
• Ultrasound: This uses sound waves to look for blockages in your ureters.
• X-ray of your belly: This may help show whether a stone is in the areas of your kidneys or ureters.
• Computed tomography (CT) scan: A CT scan can help your healthcare provider find out your ureteral stone’s size, location and hardness. It provides information to help plan treatment.

How do you treat ureteral stones?

Treatment for ureteral calculi depends on the size and location of the stones. It also depends on the substances that make up the stones. The size and location of the stones will help your healthcare provider know if you can expect to pass them.

It can take several weeks for a stone to pass. During that time, you may need medicine for pain and nausea.

If you have larger ureteral stones or a urinary tract blockage, a urologist may recommend the following:

• Shock wave lithotripsy: High-energy shock (sound) waves break up stones in your ureters. Smaller pieces of stone move through your urinary tract more easily when you pee.
• Ureteroscopy: A urologist inserts a long, thin tube with a camera into your urethra (where pee leaves your body). After getting the tube into your ureter, they remove your stone or break it up with a laser.
• Percutaneous nephrolithotomy: A urologist inserts a scope directly into your kidney through a small cut (incision) in your back to find and remove your stones. They’ll only do this for large stones.
• Ureteral stents: Ureteral stents are thin, flexible, temporary tubes that hold your ureters open. They allow pee to flow around a kidney stone that’s blocking urine flow. These are very helpful in emergency settings.
• Medical expulsive therapy (MET): MET relaxes your ureter muscles. It works best for treating small ureteral stones near your bladder. Treatments may include alpha-blockers, calcium channel blockers, corticosteroids and phosphodiesterase-5 (PDE5) inhibitors.

Medications to treat them

Medications can help people who develop certain types of ureteral calculi. Medicines include:

• Acetohydroxamic acid
• Allopurinol
• Antibiotics
• Diuretics
• Potassium citrate
• Tiopronin

Recovery time

Most people feel better within a few days after treatment. But you may have side effects that last until your body has passed the last pieces of your ureteral stones.

Your body is unique, so the amount of time it takes you to pass a ureteral stone may differ from that of someone else who has a ureteral stone. You also may not be able to pass the stone or pee it out.

In many people, a stone smaller than 4 millimeters (less than a quarter inch) may pass within one or two weeks.

Once a ureteral stone reaches your bladder, it typically passes within a few days.

When should I see my healthcare provider?

Contact a healthcare provider right away if you’re having ureteral stone symptoms. If you need it, they can prescribe medication for pain and nausea or vomiting.

If you have a ureteral stone, a healthcare provider can help locate it so you can get proper treatment.

Questions you may want to ask your provider include:

• How big is my ureteral stone?
• Where is my stone?
• How many ureteral stones do I have?
• What are my chances of being able to pass my ureteral stone?
• Do I need treatment?
• What procedure should I have to get rid of my ureteral stone?
• How can I prevent ureteral stones from developing again?

What can I expect if I have this condition?

The outlook for people with ureteral stones is good. But there’s a chance that you may develop ureterolithiasis again.

Many people pass small ureteral stones without treatment. For large ureteral stones, treatments can break up the stone so you can pass it on your own, or a healthcare provider can remove it. Medications can also help remove ureteral stones and prevent them from coming back.

If you get ureteral stones more than once, your healthcare provider can help you find out why. After their analysis, you may be able to make changes to prevent stones from forming again.

Is there anything I can do to feel better?

Drinking at least 3 liters (3 quarts) of fluid per day can help you flush out small ureteral stones.

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) help provide relief for mild pain or discomfort. The most common NSAIDs include aspirin, ibuprofen and naproxen. Not everyone can take NSAIDs, so it’s a good idea to check with your healthcare provider before use.

Can this be prevented?

There are many ways to prevent ureteral stones:

• Drink more fluids. It’s a good idea to drink at least 3 liters/quarts of fluid each day. Water is best. But other fluids, like lemonade or orange juice, are also good options.
• Limit the amount of animal protein in your meals. Animal protein — including meat, eggs and fish — increases the amount of uric acid in your system. Lentils, beans, green peas, seitan and tofu are good protein sources that won’t increase the amount of uric acid in your body.
• Limit the amount of sodium (salt) in your meals. Consuming less than 1,500 milligrams of salt per day helps reduce your chances of developing a ureteral stone. You can replace salt in your diet with salt substitutes, herbs, spices, lemon juice or flavored vinegars.
• Limit the amount of oxalate in your meals. Oxalate is a nutrient found in spinach, almonds, cashews and potatoes. Foods and drinks that have a lot of calcium can help prevent oxalate from crystallizing.

Your healthcare provider may also ask you to pee into a special strainer or filter until you pass your ureteral stones. Then, they’ll collect your stone and analyze it. Your provider can then use that information to create a treatment plan that prevents stones from forming again.