Ureteral stones why they occur and how they are treated

Ureteral stones are one of the most common health problems that can cause sudden and severe pain, sometimes making the patient unable to move or tolerate the discomfort. The condition usually begins in the kidneys, where mineral deposits accumulate and gradually form small stones that may then travel into the ureter, the tube that carries urine from the kidneys to the bladder.While some cases are mild and improve with medication and increased fluid intake, others can become serious if the stone causes a blockage in the urinary tract or affects kidney function.In this Dalily Medical article, we will explore together the causes of ureteral stones, the key symptoms to watch for, different treatment options, and when the condition may become dangerous and require urgent medical intervention.

What are ureteral stones?

Ureteral stones are solid deposits made of minerals and salts. They usually form in the kidneys and then move into the ureter, the tube that connects the kidney to the bladder. When a stone gets stuck in the ureter, it can cause partial or complete blockage of urine flow, leading to severe and uncomfortable symptoms.

The most common symptoms include severe renal colic, intense pain in the back or side, blood in the urine, and sometimes nausea. Treatment depends on the size and location of the stone and may include increased fluid intake, pain relievers, medications that help pass the stone, or procedures such as lithotripsy or ureteroscopy in larger cases.

❓ Are ureteral stones dangerous?

They are not always dangerous, but they can become serious if they cause:

Urinary tract obstruction
Kidney or urinary infections
Reduced kidney function if blockage persists for a long time

❓ Can ureteral stones pass on their own?

Yes. In many cases, small stones can pass naturally with increased fluid intake and medication that helps relax the ureter. However, larger stones usually do not pass easily and may require medical intervention such as lithotripsy or ureteroscopy.

⏳ How long does it take for a ureteral stone to pass?

Small stones may take anywhere from a few days to 3–4 weeks to pass naturally. If the stone does not pass within this period, medical intervention is often required.

❗ What is the strongest symptom of ureteral stones?

The most characteristic and severe symptom is sudden, intense pain in the side or lower back, known as renal colic. This pain often comes in waves and is considered one of the most severe types of pain a person can experience.

❓ Can ureteral stones cause blood in the urine?

Yes. Stones can scratch the lining of the ureter as they move, leading to blood in the urine, which may appear mild or clearly visible.

❓ Do ureteral stones cause burning during urination?

Sometimes. This is more common when the stone moves closer to the bladder or if a urinary tract infection develops, leading to burning or discomfort during urination.

❓ Does drinking water dissolve ureteral stones?

Drinking water does not dissolve all types of stones. However, it helps small stones pass more easily by increasing urine flow. Larger or harder stones usually require medical treatment.

When should you see a doctor urgently?

Seek immediate medical attention if you experience:

Severe, persistent pain not relieved by painkillers
Fever or chills
Difficulty or inability to urinate
Significant or visible blood in urine

❓ Can ureteral stones come back after treatment?

Yes. Stones may recur if the underlying causes are not managed, such as:

Low fluid intake
Unhealthy diet
High salt levels in the body

❓ Do ureteral stones always require surgery?

No. Not all cases require surgery:

Many cases improve with fluids and medication
Some require only lithotripsy (stone breaking)
Surgery or ureteroscopy is reserved for large, complicated stones or severe obstruction

Types of ureteral stones

1. Calcium oxalate stones

The most common type, accounting for more than 70% of cases. They form due to high calcium or oxalate levels in urine and are linked to dehydration and foods like spinach and nuts.

2. Calcium phosphate stones

Less common and often related to urine pH imbalance or chronic kidney/urinary infections.

3. Uric acid stones

Form due to high uric acid levels, common in people who consume large amounts of red meat or suffer from gout. In some cases, they can dissolve with medication.

4. Struvite stones (infection stones)

Caused by urinary tract infections. They can grow quickly and form large stones, and are more common in women due to recurrent infections.

5. Cystine stones

Rare, caused by a genetic disorder that increases cystine levels in urine. They often appear early in life and tend to recur.

⚠️ Causes of ureteral stones

1. Low water intake

Leads to concentrated urine and crystal formation.

2. High levels of urinary salts

Such as calcium, oxalate, and uric acid.

3. High salt and protein diet

Includes salty foods, red meat, and fast food.

4. Sedentary lifestyle

Lack of movement can affect mineral balance and increase stone formation.

5. Genetic factors

Family history increases risk.

6. Urinary tract infections

Certain bacteria can promote stone formation, especially struvite stones.

7. Chronic medical conditions

Such as:

Overactive parathyroid gland
Gout
Some kidney diseases

8. Lack of stone-inhibiting substances

Such as citrate in urine, which naturally helps prevent salt crystals from forming. A deficiency in citrate increases the risk of stone formation.

⚠️ Symptoms of ureteral stones

Ureteral stones (ureteric stones) usually produce clear and noticeable symptoms, especially when the stone starts moving through the ureter or causes a blockage in the urinary tract.

Main symptoms:

1. Severe side or back pain ⚡

This is the most common symptom and it is typically:

Sudden and very intense
Usually felt on one side of the body
May radiate to the abdomen, lower pelvis, or groin

2. Intermittent renal colic

The pain comes in waves:

It becomes severe, then eases, then returns again
This pattern is known as renal colic

3. Pain or burning during urination

This may occur when the stone moves closer to the bladder or irritates the urinary tract.

4. Frequent urination or urgency

The patient feels the need to urinate frequently, even if only small amounts are passed.

5. Blood in urine

Urine may appear pink, red, or light brown due to irritation of the ureter lining by the stone.

6. Nausea and vomiting

This happens as a result of severe pain and its effect on the nervous and digestive systems.

7. Difficulty urinating

Occurs when there is partial or complete blockage in the ureter.

8. Fever or chills

These symptoms may appear if there is an associated infection and require urgent medical attention.

Diagnosis of ureteral stones

Diagnosis involves several steps to accurately determine the presence, size, and location of the stone.

1. Medical history

The doctor may ask about:

Location and severity of pain
Whether the pain comes in waves
Presence of burning or blood in urine
History of kidney stones or urinary infections

2. Physical examination

Includes:

Examining the abdomen and back
Identifying the exact location of pain
Observing patient discomfort due to severe colic

3. Urine analysis

Helps detect:

Blood in urine
Excess salts
Signs of infection such as pus or bacteria

4. Blood tests

Used to evaluate:

Kidney function (creatinine and urea)
Levels of calcium and uric acid

5. Imaging tests (most accurate tools)

1. Non-contrast CT scan (CT KUB) ⭐

The most accurate test for ureteral stones, showing:

Exact stone size
Exact location
Degree of obstruction

2. Ultrasound

Detects kidney or ureter swelling
Helpful but may miss small stones

3. Plain abdominal X-ray (KUB)

Can show some types of stones
Less accurate than CT

⚠️ Complications of ureteral stones

If not treated properly, ureteral stones may cause several health complications:

1. Severe pain (renal colic)

One of the most intense types of pain
May prevent sleep or movement
Comes in repeated attacks

2. Urinary obstruction

Partial or complete blockage
Reduced urination
Increased pressure on the kidney
Kidney swelling (hydronephrosis)

3. Kidney function deterioration

If obstruction persists:

Kidney efficiency decreases
Possible permanent damage in advanced cases

4. Urinary tract infections

Stones can promote bacterial growth, leading to:

Kidney or ureter infection
Fever and chills
Burning during urination

5. Blood in urine

Due to friction between the stone and ureter lining.

6. Nausea and vomiting

A result of severe pain and nervous system stimulation.

7. Recurrence of stones

If underlying causes are not treated, stones may form again.

⚠️ Complications of ureteral stones (advanced cases)

1. Complete ureter obstruction

Urine flow stops or becomes severely reduced
High pressure on kidneys
Kidney swelling (hydronephrosis)

2. Severe kidney damage

Gradual loss of kidney function
In rare cases, partial or complete kidney failure

3. Severe infections

May lead to:

Acute pyelonephritis (kidney infection)
High fever
Severe pain and burning urination
In extreme cases: sepsis (blood infection)

4. Recurrent severe renal colic

Repeated painful attacks
May require strong pain medication or intervention

5. Urinary retention ????

Difficulty or inability to urinate
Lower abdominal pain and pressure

6. Persistent or increased hematuria

Ongoing blood in urine due to irritation

7. Increased risk of recurrence

Without lifestyle changes, stones are likely to return

Medical treatment of ureteral stones

Treatment depends on stone size, location, and symptom severity.

???? Goals of drug therapy:

Pain relief
Facilitating stone passage
Preventing infection

1. Painkillers

Commonly used:

NSAIDs (e.g., ibuprofen, diclofenac)
Sometimes stronger analgesics if needed

Effects:

Reduce pain intensity
Relieve ureter spasm
Help stone movement

2. Stone-expulsion therapy

(Alpha-blockers like tamsulosin)

How it works:

Relaxes ureter muscles
Widens urinary passage
Helps stone pass more easily

✔ Most effective for small to medium stones (usually <10 mm)

3. Diuretics (used carefully)

Increase urine flow
Must be used under medical supervision

4. Antibiotics

Used only if infection is present:

Fever
Pus in urine
Severe burning

5. Treatment based on stone type

For uric acid stones:

Medications that reduce uric acid
Drugs that alkalinize urine to help dissolve stones

When is medical treatment enough?

Small stone (usually <5–7 mm)
No severe obstruction
No infection
Normal kidney function

❌ When is medical treatment NOT enough?

Severe persistent pain
Complete obstruction
High fever or infection
Large stone that does not pass

Surgical treatment of ureteral stones

Used when medication fails or complications occur.

1. Ureteroscopy (URS)

A thin scope is inserted through the urinary tract to reach the stone.

Uses:

Medium and large stones
Failed medical treatment

Treatment:

Laser fragmentation
Or stone removal

✔ High success rate
✔ No external incision
✔ Fast recovery

2. ESWL (Shock wave lithotripsy)

External shock waves break stones into small pieces.

✔ Non-invasive
✔ No surgery needed
❌ May require multiple sessions

3. PCNL (Percutaneous nephrolithotomy)

A small incision in the back is used to remove large or complex stones.

✔ Very effective for large stones
❌ More invasive than other methods

4. Open surgery (rare)

Used only in very complex cases today.

Exercises that may help stone passage

Walking briskly
Climbing stairs
Light stretching
Gentle jumping (only small stones)
Stationary cycling

⚠️ Only supportive—not a replacement for treatment.

Prevention of ureteral stones

Drink 2–3 liters of water daily
Reduce salt intake
Limit red meat consumption
Avoid high-oxalate foods (spinach, nuts, chocolate)
Exercise regularly
Eat citrus fruits (lemon increases citrate)
Avoid holding urine
Regular medical check-ups

???? Reduce salt intake

Avoid excessive consumption of salty foods such as pickles and fast food.
High sodium intake increases calcium levels in the urine, which promotes the formation of kidney stones.

???? Moderate animal protein intake

Reduce excessive consumption of red meat and animal protein.
Maintain a balanced diet rich in vegetables and healthy foods.
High animal protein intake can increase uric acid levels, which contributes to stone formation.