Ureteric Stone: Symptoms, Treatment & When to Act
- What is a ureteric stone? (The “painful stone”)
- Symptoms of ureteric stones – colic, radiation, nausea
- Symptoms by stone location (upper, mid, lower ureter)
- Treatment options: medical therapy vs URS vs ESWL
- Medical expulsion therapy (tamsulosin, nifedipine)
- Complications of untreated ureteric stones (hydronephrosis, infection)
- Interactive FAQ – 9 common questions
What is a ureteric stone? (The “painful stone”)
A ureteric stone is a kidney stone that has moved out of the kidney and become lodged in the ureter – the narrow, muscular tube that carries urine from the kidney to the bladder. This is where stones cause the most trouble. The ureter is only 2‑4mm wide, so even a small stone (3‑4mm) can cause complete obstruction and severe pain.
Ureteric stones account for the majority of emergency room visits for kidney stones. Unlike stones still inside the kidney (which may be painless), a ureteric stone almost always causes symptoms. At Vivekananda Hospital, we see dozens of patients with ureteric stones every week, and most require intervention.
Symptoms of ureteric stones – colic, radiation, nausea
The classic symptom of a ureteric stone is renal colic – severe, intermittent pain that comes in waves. Here is what to expect:
- Pain: Sudden onset, often described as the worst pain of the patient’s life. It starts in the flank (side of the back) and may radiate to the lower abdomen, groin, or inner thigh.
- Waves of pain: Each wave lasts 20‑60 minutes, corresponding to ureteral peristalsis. Between waves, pain may completely disappear.
- Nausea and vomiting: Extremely common – the ureter and stomach share nerve pathways (T10‑T12). Patients often vomit repeatedly.
- Hematuria (blood in urine): Visible or microscopic. Usually appears with pain.
- Urinary urgency/frequency: When the stone is near the bladder (UVJ), it irritates the bladder trigone, causing a constant urge to urinate.
Symptoms by stone location (upper, mid, lower ureter)
Where the stone is stuck changes the pain pattern and urgency:
- Upper ureter (near kidney – UPJ): Pain is typically in the flank or upper abdomen. May mimic a kidney infection. High risk of hydronephrosis.
- Mid ureter (crossing the pelvic brim): Pain radiates to the lower abdomen and groin. Often mistaken for appendicitis (right side) or diverticulitis (left side).
- Lower ureter (near bladder – UVJ): Pain is suprapubic (lower abdomen) and radiates to the tip of the penis or labia. Causes severe urgency and frequency. This is the most common site for stones to get stuck.
At Vivekananda Hospital, we use non‑contrast CT to pinpoint the stone’s exact location, which guides treatment decisions.
Treatment options: medical therapy vs URS vs ESWL
The best treatment for a ureteric stone depends on its size, location, and your symptoms. Here is a comparison table:
| Stone size & location | First‑line treatment | Success rate |
|---|---|---|
| <5mm, any location | Medical expulsion therapy (tamsulosin + hydration) for 4‑6 weeks | 70‑90% passage |
| 5‑7mm, lower ureter | URS with laser (preferred) or medical therapy trial | 90‑95% (URS), 40‑60% (medical) |
| 5‑7mm, mid/upper ureter | URS or ESWL | URS: 85‑90%, ESWL: 60‑70% |
| 8‑10mm, any location | URS with laser (first line). ESWL possible for upper ureter | URS: 90‑95%, ESWL: 50‑60% |
| >10mm | URS (or PCNL for very large) | 95% |
Medical expulsion therapy (tamsulosin, nifedipine)
For small ureteric stones (<5‑6mm), a trial of medical expulsion therapy (MET) is reasonable. MET uses medications that relax the ureter, helping the stone pass faster and with less pain.
- Tamsulosin (Flomax): 0.4 mg once daily (bedtime). Alpha‑blocker that relaxes ureteral smooth muscle. Increases passage rates by 30‑40%.
- Nifedipine (alternative): 30 mg once daily. Calcium channel blocker. Less commonly used due to side effects (headache, flushing).
- Hydration: 2.5‑3 litres of water daily.
- Pain relief: NSAIDs (ibuprofen) as needed.
Duration: 4‑6 weeks. If the stone has not passed by 6 weeks, spontaneous passage is unlikely, and URS is recommended. Do not extend MET beyond 6 weeks – risk of kidney damage increases.
Complications of untreated ureteric stones (hydronephrosis, infection)
Leaving a ureteric stone untreated is dangerous. Complications include:
- Hydronephrosis: The kidney swells as urine backs up. Complete obstruction for >2‑4 weeks can cause permanent kidney damage.
- Pyelonephritis (infected obstruction): Bacteria multiply above the stone. This is a urological emergency requiring immediate drainage (stent or PCN tube) and antibiotics.
- Ureteral stricture: Long‑term impaction can scar the ureter, causing permanent narrowing that requires surgical repair.
- Renal failure: Bilateral ureteric stones or a stone in a solitary kidney can lead to acute kidney injury and even anuria (no urine output).
Interactive FAQ – Ureteric stones
If completely obstructing, significant kidney damage can occur after 2‑4 weeks. That is why we do not wait longer than 4‑6 weeks for passage. Partial obstruction may be tolerated longer but still risky.
Possibly, but only 40‑60% pass, depending on location. Lower ureter stones have a better chance (60%). If you try MET, you need follow‑up imaging to ensure it is moving.
NSAIDs (ibuprofen, diclofenac) are more effective than paracetamol or opioids. They reduce ureteral spasm and inflammation. For severe pain, intravenous diclofenac or ketorolac works best.
The procedure is done under anaesthesia – you feel nothing. Afterward, most discomfort is from the stent, not the surgery. Stent symptoms (urgency, flank pain) resolve after removal.
Yes. The stone can harbour bacteria and obstruct urine flow, leading to pyelonephritis. Fever with a ureteric stone is a medical emergency.
Non‑contrast CT scan (CT KUB) is the gold standard. It shows stone size, location, degree of hydronephrosis, and stone density. Ultrasound is less accurate but can detect hydronephrosis.
About 60‑70% after one session. If the stone is dense (>900 HU), success drops to 50%. URS has a 90% success rate for the same stone.
Yes, but if the stone moves during the flight, you could have severe pain at 30,000 feet. Better to treat the stone before long travel. If you must fly, carry painkillers and stay hydrated.
It can become embedded (impacted) in the ureteral wall. This makes URS more difficult and may lead to stricture, hydronephrosis, and kidney loss. Do not leave a stone indefinitely.
Disclaimer: A ureteric stone is a medical condition that requires prompt evaluation. If you have severe colicky pain, fever, or decreased urine output, visit Vivekananda Hospital immediately. Do not rely on home remedies for a stone in the ureter.