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Ureteric Stones: Treatment & Prevention

What are ureteric stones?

Stones or calculi can form anywhere in the urinary tract, causing pain, bleeding, blockage in urine flow or infection. A stone is named based on where it forms, and so could be called a kidney stone, bladder stone or ureteral stone.

There are different types of stones that may form in the urinary tract:

  • Minerals in urine can form crystals that develop into stones (Most common stones are made of calcium).
  • Struvite stones are a mixture of ammonium, magnesium and phosphate. These are also called infection stones.

What are the causes of the disorder?

Stones develop because of urine saturation with salts and a lack of usual substances that inhibit stone formation (citrate is an inhibitor that binds calcium). The risk of stone formation is high in people with specific disorders like dehydration, renal tubular acidosis or hyperarathyroidism. Some people may also have a family history of stones in urinary tract. Further, weight loss surgery patients are also at an increased risk of developing stones.

What one needs to know about symptoms or signs?

Small stones may not cause symptoms. However, stones that obstruct the ureter may cause the following symptoms:

  • Pain in the bladder
  • Pain in lower abdomen
  • Intense pain felt between the ribs and hip (renal colic), which spreads across the abdomen and may reach inner thigh. The pain is felt in waves and may radiate down the abdomen.
  • Nausea, vomiting
  • Sweating
  • Blood in urine
  • Chills or fever

Which specialist should be consulted in case of signs and symptoms?

In case of above symptoms, a person must consult a urologist or nephrologist.

What are the screening tests and investigations done to confirm or rule out the disorder?

Ureteric stones diagnosis involves the following:

  • Physical examThe doctor looks for renal colic pain or pain in the back extending to groin.
  • Helical computed tomography This is the most definitive diagnostic tool to look for stones in the ureter.
  • Ultrasonography This is also useful in visualising the stone.
  • X-rayAn x-ray is is not a sefficient is detecting stones, except calcium stones. Excretory urography is a series of x-rays taken after injecting a dye.
  • Urinalysis A urine sample is taken to look for blood or pus in the urine.

What treatment modalities are available for management of the disorder?

Very small stone soften pass on their own and may not require treatment. Larger stones, however, are less likely to pass on their own. Treatment may involve:

  • Pain relievers – Nonsteroidal anti-inflammatory drugs (NSAIDs) or opiods may be given.
  • Stent – A severe blockage may require inserting a stent or tube in the ureter to bypass the stone. The stent is passed through a viewing tube called cystoscope. The stent is placed inside till the stone gets removed.
  • Drainage – The stone blockage may also be removed by insertinga  drainage tube through the skin.
  • Shock waves – Stones in the upper ureter are broken up using shock waves. The broken pieces then pass through urine.
  • Holmium laser lithotripsy – This method uses laser to break the stone.

How can the disorder be prevented from happening or recurring?

Certain lifestyle changes may be included to prevent occurrence or recurrence of ureteric stones:

  • Increasing fluid intake to 2-3 litres daily.
  • Keeping calcium intake at normal levels.
  • Reducing salt intake.
  • Taking preventive medication as guided by doctor.

 

Sources:

“Kidney Stone in Ureter,” WebMD.com, http://www.webmd.com/kidney-stones/kidney-stone-in-ureter

“Stones in the Urinary Tract,” MerckManuals.com, http://www.merckmanuals.com/home/kidney_and_urinary_tract_disorders/stones_in_the_urinary_tract/stones_in_the_urinary_tract.html