How does a stone get into the ureter?
Almost all ureteral stones initially form in the kidney. When the stone breaks away from the wall of the calyx and begins to move downwards, it enters the ureter - a thin channel about 30 centimeters long that connects the kidney to the bladder.
There are three physiological narrowings in the ureter where the stone most often gets stuck: the exit point from the renal pelvis, the area of intersection with the iliac vessels, and the entrance to the bladder. It is at these levels that seizures occur.
While the stone moves, the wall of the ureter reacts with spasm and edema, which further blocks the lumen. Urine continues to be produced by the kidney, but cannot come out - the pressure inside the renal pelvis increases, and this causes characteristic paroxysmal pain.
Symptoms of a stone in the ureter
- Sudden severe paroxysmal pain in the lower back or side on one side
- Radiation of pain downwards: to the groin, external genitalia, inner thigh
- Restless behavior - a person cannot find a comfortable position, unlike abdominal pain, in which the patient freezes
- Nausea, vomiting, bloating, gas retention
- Blood in urine - from microscopic to visible to the eye
- Frequent, painful urination and false urge due to a stone in the lower third of the ureter
- Decreased urine output
- Increase in temperature due to infection
Diagnostics
- CT scan of the urinary system without contrast is the method of choice: shows a stone of any composition, its exact size, density and level of standing
- Ultrasound of the kidneys - reveals the expansion of the pyelocaliceal system; The stone itself in the middle third of the ureter is often not seen by ultrasound
- Survey urography - sees X-ray positive stones
- General urine analysis - red blood cells, white blood cells, salt crystals
- Urine culture for suspected infection
- Blood creatinine to assess kidney function
- Excretory urography or dynamic scintigraphy for long-term obstruction
Stone density according to CT is of practical importance: very dense stones are difficult to crush remotely, and contact lithotripsy is immediately planned for them.
Will the stone come out on its own?
The likelihood of spontaneous passage depends primarily on the size and level of the stone.
- Up to 4–5 mm - go away on their own in most cases, especially from the lower third of the ureter
- 5–7 mm - recedes less frequently, requires observation and medicinal support
- More than 7–8 mm – they rarely come out on their own; active tactics are usually needed
- Stones in the upper third of the ureter pass less easily than stones in the lower third of the same size.
Observational tactics are permissible only if pain is controlled, there is no infection and kidney function is preserved. It cannot be delayed: prolonged standing of the stone leads to the formation of a cicatricial stricture of the ureter and irreversible damage to the kidney.
Treatment: stone removal methods
- Contact ureterolithotripsy - an endoscope is passed through the urethra and bladder to the stone; the calculus is destroyed by a laser and the fragments are removed. The most universal method for ureteral stones of any density
- Pneumatic crushing - the stone is destroyed by mechanical impulses of the probe; effective for dense stones
- External shock wave lithotripsy (ESWL) - without insertion of instruments, suitable for stones of the upper third of the ureter of small density
- RIRS - flexible ureterorenoscopy, used when the stone has migrated back into the kidney
- Laparoscopic ureterolithotomy - for large, long-standing and impacted stones, when endoscopic methods do not produce results
- Ureteral stenting - installed for emergency restoration of urine outflow, as well as after fragmentation for the prevention of edema and obstruction by fragments
- Percutaneous nephrostomy - for severe purulent inflammation, when it is impossible to insert a stent
What to do during an attack
- Обратиться за медицинской помощью — почечная колика требует врачебной оценки и адекватного обезболивания
- Не принимать мочегонные и не пить большими объёмами: при перекрытом мочеточнике это усиливает давление в почке
- Не прикладывать тепло при повышенной температуре
- Сохранить отошедший камень, если он вышел, — его состав определит профилактику
- Не откладывать обследование после того, как приступ прошёл: стихание боли не означает, что камень вышел, — иногда это признак того, что почка перестала функционировать
After stone removal
- Keep drinking water to wash away small fragments
- Control ultrasound or CT scan at the time prescribed by the doctor
- Remove the stent in a timely manner - an expired stent becomes overgrown with salts and becomes a source of problems itself
- Submit the stone for composition analysis
- Undergo metabolic testing for recurrent stones
- Adjust nutrition and drinking regimen based on the results of the analysis
Where are stones in the ureter treated in Tashkent
Treatment of ureteral stones requires round-the-clock availability: CT, endoscopic stand with laser, operating room and hospital. In case of a complicated course, help is needed in the next few hours.
In Tashkent, contact laser and pneumatic crushing of ureteral stones, stenting and laparoscopic operations are performed at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If you have a CT or ultrasound scan on hand, take the pictures and the disk with you - this will speed up the decision-making process and avoid repeated examinations. Contacts and online registration are below on the page.
