How to Pass a Ureteral Stone? Medication or Surgery?

This article was translated from the original Portuguese. Português

Do you know the ways to eliminate a stone in the ureter?

Stones (calculi) can originate anywhere in the urinary system, from the kidney to the urethra.

Stones that form in the kidney can move and migrate toward the ureter, leading to a sudden interruption of urine flow, increased pressure in the urinary system and very intense pain. This set of symptoms is called renal colic. (see in this video what to do during a renal colic attack)

The ureter has three points where it is narrowest. The first is right where it leaves the kidney, the second is at the transition between the abdomen and the pelvis, and the third, the narrowest of all, is at the entrance to the bladder.

The closer to the bladder, the narrower the ureter, which increases the likelihood of a stone becoming lodged.

The figure below illustrates the 3 narrowest points of the ureter (and those most likely to be obstructed by a stone).

Watch a video of a real operation: here

There are basically two ways to eliminate stones in the ureter:

1- Conservative medical treatment with medication: in this approach, the urologist uses medications such as tamsulosin, which dilate the portion of the ureter closest to the bladder, thereby increasing the chances of the stone passing. (1)

In addition, the patient is advised to drink large amounts of fluids and to take anti-inflammatory medications or drugs that help relieve colic symptoms (such as ketoprofen and scopolamine). This strategy is up to 80% effective for people with impacted stones of up to 7 mm.

2- Surgery (laser lithotripsy): the surgery is a procedure that requires no incisions in the abdomen.

The patient is taken to the operating room and, under general anesthesia, a micro camera slightly thicker than a ballpoint pen refill is inserted through the urethra.

With direct visualization of the urinary system, aided by real-time X-ray imaging, the urologist accesses the ureter, identifies the impacted stone, breaks it up with a laser microfiber at the tip of the instrument and removes the small fragments with a special grasper.(2–4)

After the ureter is unblocked, a double-J stent may need to be placed to ensure that urine flow is not interrupted again due to the (natural) swelling of the ureter after invasive surgical procedures like this one.

The double-J stent may remain in place for three to 60 days, depending on each case.

Watch the video we recorded on how a double-J stent is removed.

Written by:

References:

1. Fontenelle LF, Sarti TD. Kidney Stones: Treatment and Prevention. Am Fam Physician. April 15, 2019;99(8):490–6.

2. Astolfi RH, Carrera R, Gattas N, Bertolla R, Sepulveda F, Reggio E, et al. Current scenario of endourological treatment of kidney stones in brazil: results of a national survey. Int Braz J Urol Off J Braz Soc Urol. June 2020;46(3):400–8.

3. Barone B, Crocetto F, Vitale R, Di Domenico D, Caputo V, Romano F, et al. Retrograde Intra Renal Surgery (RIRS) versus Percutaneous Nephrolithotomy (PCNL) for renal stones >2cm. A systematic review and meta-analysis. Minerva Urol E Nefrol Ital J Urol Nephrol. February 19, 2020;

4. Khan A. Prevalence, pathophysiological mechanisms and factors affecting urolithiasis. Int Urol Nephrol. May 2018;50(5):799–806.

Dr. Bruno Benigno
Urologist and uro-oncologic surgeon (CRM-SP 126.265 · RQE 60022). More than 1,500 robotic surgeries. Member of the AUA, EAU and SBU. Meet Dr. Bruno · In the Media

This content is educational and does not replace a medical consultation. Each case must be assessed individually, based on AUA, EAU and NCCN guidelines.