Ureteral Stones

What is a ureteral stone?

A ureteral (pronounced “yer-ree-ter-uhl”) stone is an irregularly shaped solid mass or crystal that’s become stuck in one of your ureters (pronounced “yer-it-ters”). Your ureters are two tubes of muscle that carry urine (pee) from your kidneys to your bladder. You have one ureter per kidney.

Ureteral stones can appear in your left ureter or your right ureter. In most adults, your ureters are between 10 inches and 12 inches long. Stones may be near the proximal end (near the point of origin) or the distal end (away from the point of origin) of your ureter. The proximal end of your ureter connects to your renal pelvis. There’s a renal pelvis in the center of each of your kidneys, and it collects pee. The distal end of your ureter connects to your bladder.

Ureteral stones are often tiny. Some are too small to see with the naked eye. They pass through your pee and don’t cause any problems.

If a ureteral stone is large enough, it can block the flow of pee from your kidneys to your bladder. This blockage can cause severe pain. Ureteral stones form when minerals and salts build up in your pee. The minerals form crystals that grow into stones.

Are ureteral stones kidney stones?

Yes, ureteral stones are kidney stones. A ureteral stone is a kidney stone that’s become stuck in one of your ureters.

What are the main types of ureteral stones?

There are four main types of ureteral stones, including:

• Calcium stones. Calcium stones are the most common type of ureteral stone. 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 are the main components of struvite stones.
• Cystine stones. The genetic disorder cystinuria (pronounced “sis-tah-nuhr-ee-ah”) causes cystine stones. Cystinuria causes the amino acid cystine to leak out of your kidneys into your pee.

Who do ureteral stones affect?

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

• Are a man or were assigned male at birth.
• Are white.
• Are between the ages of 40 and 60.
• Have had ureteral stones before.
• Have a family history of ureteral stones.
• Don’t drink a lot of water.
• Have diabetes.
• Have polycystic kidney disease.

How common are ureteral stones?

Each year in the United States, about 1 in 1,000 adults goes to the hospital for urinary tract stones.

Over your lifetime, you have a 1 in 8 chance of forming a stone.

What are the symptoms of a ureteral stone?

If you have tiny ureteral stones, they may pass through your urinary system on their own without any symptoms.

However, stones that block your ureters or any of your kidneys’ drainage tubes may cause symptoms that include:

• Severe pain that comes and goes (intermittent) in your upper flank (in your back, under your lower ribs).
• Pain that spreads (radiates) to your lower abdomen.
• Pain or a burning feeling while peeing.
• Nausea.
• Vomiting.
• Bloody or discolored pee (brown, pink or red).
• Cloudy pee.
• Frequent urges to pee.
• Peeing only a small amount.

What causes ureteral stones?

Ureteral stones form when there’s too much of a stone-forming substance in your pee. The substances that make up ureteral stones usually pass through your urinary system without issue. When they don’t, it’s because there isn’t enough pee in your body to dissolve or flush the substances, usually because you’re not drinking enough water. The substances then start to crystalize.

What substances make up ureteral stones?

The following substances make up ureteral stones:

• Calcium.
• Oxalate.
• Uric acid.
• Phosphate.
• Cystine.
• Xanthine.

How long can a stone stay in my ureter?

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

In many people, a stone smaller than 4 millimeters may pass within one or two weeks.

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

How are ureteral stones diagnosed?

A healthcare provider will ask about your symptoms and perform a physical exam. They’ll also order tests to confirm the presence of ureteral stones.

What tests will be done to diagnose ureteral stones?

Tests to diagnose ureteral stones include:

• Urinalysis. A urinalysis will look for signs of infection and examine substance levels in your pee that cause ureteral stones.
• Blood test. A blood test will reveal how well your kidneys are functioning, check for infection and look for other problems that may cause ureteral stones.
• Ultrasound. An ultrasound uses sound waves to look for blockages in your ureters.
• Computed tomography (CT) scan. A CT scan can help your healthcare provider determine your ureteral stone’s size, location and hardness.

How do you get rid of ureteral stones?

Getting rid of ureteral stones depends on the size and location of the stones. It also depends on what substances make up the stones. The size and location of the stone will give your healthcare provider a good idea as to whether or not you can pass it.

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

• Shock wave lithotripsy. This procedure uses high-energy shock (sound) waves to break up stones in your ureters. The smaller pieces of your stones move through your urinary tract more easily when you pee. Shock wave lithotripsy is the least invasive treatment option but may not be right for all people.
• Ureteroscopy. A urologist inserts a long, thin tube with a camera (ureteroscope) into your urethra (where pee leaves your body). They feed the ureteroscope through your bladder and into your ureter. Once they find your stone, they remove it or break it up with a laser.
• Percutaneous nephrolithotomy. During percutaneous nephrolithotomy (pronounced “per-cue-tae-nee-us neff-ro-lie-thot-oh-mee”), a urologist inserts a scope directly into your kidney through a small cut (incision) in your back to find and remove your stones. The urologist will only recommend this procedure if your stones are large or irregularly shaped.
• 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.
• Medical expulsive therapy (MET). MET is most effective at treating small distal ureteral stones. Treatments may include alpha-blockers, calcium channel blockers, corticosteroids and phosphodiesterase-5 inhibitors (PDE5).

What medications are used to treat ureteral stones?

Medications can help people who develop certain types of ureteral stones:

Calcium stones

• Potassium citrate. This makes your pee more alkaline and less acidic.
• Diuretics. These help you move extra fluid and calcium out of your body when you pee.

Struvite stones

• Antibiotics. These are drugs that fight bacterial infections.
• Acetohydroxamic acid. This helps prevent the buildup of ammonia in your pee.

Cystine stones

• Tiopronin(mercaptopropionyl glycine). This helps prevent kidney stones in people with cystinuria.
• Potassium citrate.

How do I take care of myself/manage symptoms?

It’s a good idea to drink plenty of fluids. Drinking at least 2 liters to 3 liters of fluid per day can help you pass 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 (Bayer®), ibuprofen (Advil®) and naproxen (Aleve®). Not everyone can take NSAIDs, so it’s a good idea to check with your healthcare provider before use.

How long does it take to recover from this treatment?

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

How can I prevent ureteral stones?

There are many ways to prevent ureteral stones:

• Drink more fluids. It’s a good idea to drink at least 2 liters to 3 liters of fluid each day. Water is best, but other fluids, such as lemonade or orange juice, are also good options.
• Limit the amount of animal protein in your diet. 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 diet. 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 diet. 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 crystalizing.

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 to determine its chemical makeup. Your healthcare provider can then use that information to create a treatment plan that prevents stones from forming again.

What can I expect if I have ureteral stones?

With proper diagnosis, the outlook for people with ureteral stones is good. However, there’s a chance that you may develop ureteral stones 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 determine why. After their analysis, you may be able to make changes to prevent stones from developing again.

When should I see my healthcare provider?

Contact a healthcare provider right away if you’re experiencing ureteral stone symptoms. If your pain is unbearable, 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.

What questions should I ask my healthcare provider?

• How can you tell that I have a ureteral stone?
• If I don’t have a ureteral stone, what other condition might I have?
• What type of ureteral stone do I have?
• How big is my ureteral stone?
• In which ureter is my stone?
• How many ureteral stones do I have?
• Will I be able to pass my ureteral stone, or 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 changes should I make to my diet?
• Should I take any medications to prevent ureteral stones from developing again?

A note from Cleveland Clinic

Ureteral stones can be annoying and painful. However, they’re a temporary condition. Your healthcare provider can help prevent your symptoms from getting worse, so it’s a good idea to contact them as soon as you notice ureteral stone symptoms. They can also give you guidelines to help ureteral stones from developing again.