Urologist
What are the symptoms of ureteral stones?
Pain from a ureteral stone is usually more intense than pain from a stone within the kidney. A stone that does not obstruct the kidney's channels generally does not cause much pain, but once the stone moves into the ureter, it causes obstruction because the ureter is narrower than the kidney's channels, leading to severe flank pain. Along with the flank pain, nausea and pain in the same-side testicle or vaginal entrance may occur. Especially stones that have moved further along the ureter and are approaching the bladder can also cause a burning sensation during urination and a constant feeling of needing to urinate.
Although it is rare, sometimes it may not cause any pain at all. While this might seem like a stroke of luck, it can lead to a delay in treatment because the patient does not feel the condition, potentially resulting in kidney loss. Sometimes, the pain we dislike can protect us from bigger problems in the future.
What are the treatment alternatives for ureteral stones?
The treatment options for stones located anywhere in the urinary tract are the same for ureteral stones:
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Medication
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Surgery
In which patient is stone passage expected on its own?
The decision on whether to perform a procedure and which procedure to use varies from patient to patient. The most important factors influencing the choice are: 1. the size of the stone, 2. the location of the stone, 3. the condition of the kidney. In some cases, a combination of treatments may be possible, and in such cases, the patient's preference will guide the doctor's decision.
How is ureteral stone treatment done with medication?
This treatment can be divided into two categories:
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Expanding the urinary tract (ureter):
If the stone is smaller than 7mm, has passed from the kidney into the ureter, and has not caused excessive swelling or inflammation in the kidney, this method may be considered. The expected waiting time for the stone to pass should not exceed one month, as stones that do not pass within a month are unlikely to pass later. There are medications that have been proven to expand the urinary tract and help pass the stone (selective alpha-blockers, also used for prostate enlargement). -
Shrinking the stone:
Medications taken orally that can shrink the stone are extremely limited and may only work for one type of stone (uric acid stones). This is a long-term treatment and should not be used if there is an infection or dilation (swelling) in the kidney due to the stone.
Unfortunately, medication options for stone treatment are limited, and their success rate is lower and slower compared to surgery or external lithotripsy.
How is ESWL treatment performed for ureteral stones?
Shock waves are focused on the stone to break it into small fragments that can pass out. These shock waves cause little to no damage to surrounding soft tissues, such as the urinary tract (ureter), while breaking the stone. ESWL can be used for stones smaller than 1 cm in the ureter.
Not all types of stones can be fragmented by ESWL. It is not possible to determine the stone type without laboratory analysis. If the patient has a history of cystine or whewellite stones, these stones are too hard to be broken by ESWL, so the treatment is not recommended for these patients.
Although the type of stone cannot be determined before treatment, its density can be measured on a CT scan. If the stone density is greater than 1000 HU, the likelihood of the stone being fragmented by ESWL is low.
If after three sessions of ESWL the stone has not fragmented into small enough pieces to pass, continuing ESWL treatment is not recommended.
When is a Double J catheter used in URS surgery?
If the stone cannot be reached during surgery, cannot be broken, or if a large number of stone fragments are formed after the stone is broken and it is not possible to remove all fragments, and if there is suspicion of ureteral obstruction due to edema in the ureter wall after the stone is removed, a Double JJ catheter is placed at the end of the surgery to help prevent obstruction.
