A ureteral stone is a deposit in the ureter. In most cases, a ureteral stone goes away on its own.
What is a ureteral stone?
In medicine, a ureteral stone is also known as a ureteral calculus. Ureteral stones are so-called concretions, solidified masses that can be deposited in a hollow organ such as the ureter, for example. Such a concretion is called a ureteral stone, among other things, because it resembles a stone in appearance. Depending on the number and shape of ureteral stones and their location, the deposits in the ureter can cause mild to colicky pain. Since ureteral stone can cause damage to the urethral mucosa, in some cases there is slight bleeding that can be detected in the urine. Ureteral calculus occurs with equal frequency in women and men. At the same time, the risk of developing ureteral stones increases with age.
Causes
A ureteral stone is often caused by urine that is too concentrated or by too high a concentration of certain substances in the body. Corresponding substances cannot dissolve in the urine and crystals form – just like the ureteral stone. Possible causes of an increased concentration of various substances and a subsequent ureteral stone are, for example, an unbalanced diet and/or existing metabolic diseases. The intake of various medications can also promote the occurrence of ureteral stones. Furthermore, a ureteral stone can be favored by existing inflammations of the urinary draining organs. Since the body of a healthy person produces substances that inhibit the development of a ureteral stone, another possible cause of calculus formation is a deficiency of corresponding endogenous substances. However, the causes underlying a ureteral stone cannot always be clearly identified.
Symptoms, complaints and signs
Ureteral stones can cause quite different symptoms. For example, ureteral stones can remain completely asymptomatic for a long period of time. Sometimes traces of blood are found in a laboratory examination of the urine, but they were not visible at all to the naked eye of those affected. Blood in the urine, visible and invisible, can be a first indication of a ureteral stone, because depending on its location and size, it triggers injuries to the mucous membranes. However, ureteral stones can also cause serious pain that requires immediate examination and treatment. This is especially the case if the ureteral stone starts to move and, for example, pushes itself transversely into the ureter. Complete or partial prevention of urine outflow would be the result, which can lead to internal poisoning. However, a transverse stone that obstructs the ureter also causes very severe pain in affected individuals. The pain is usually described as colicky and of almost unbearable intensity. Indications of a ureteral stone are sometimes found as incidental findings in ultrasound. Depending on the size and location, further treatment must be discussed with the specialist, because large stones in particular can lead to colic. Small ureteral stones that do not cause discomfort to the affected person often go away on their own and can often be waited out without treatment under medical supervision.
Diagnosis and course
In order to diagnose a ureteral stone and its causes, a patient interview usually takes place first. In this conversation, the attending physician asks, for example, about a patient’s symptoms; inquiries may be made, for example, about a red coloration of the urine and/or a ureteral stone that has already occurred in the past. The patient’s medical history is usually followed by a physical examination. In addition to blood and urine tests, X-rays or ultrasound images can be taken to visualize a ureteral stone. If a ureteral stone is present, the course of the disease depends, among other things, on the size and position of the stone; smaller stones can, for example, disappear by themselves after some time with the help of supportive measures (such as sufficient drinking). If this does not happen, various therapeutic measures may become necessary. Possible complications associated with a urinary stone include inflammation of the urinary tract; pathogens can spread from here to the kidney and/or blood.If the urine backs up into the kidney when the urinary calculus is very large, this can lead to severe kidney damage.
Complications
A ureteral stone blocks the outlets of urine, which can back up as a result. This increases the risk that the urinary tract or even the kidney will become inflamed. In the worst case, the inflammation can spread systemically throughout the entire body, leading to sepsis. This can lead to multiple organ failure. Furthermore, the urine can build up to the kidney, which can expand due to this and thus lead to a water sack kidney (hydronephrosis). In the course of time, the kidney can fail because of this (renal insufficiency), so that the quality of life of the affected person is severely impaired. The kidney has problems excreting enough acids, so that they accumulate in the body and overacidify it. Potassium ions are also no longer excreted adequately, which also accumulate and can lead to cardiac arrhythmias. In addition, not enough water is excreted. This remains in the blood and the heart has to do more work, the blood pressure rises. Over the long term, this can end in atherosclerosis. Increased edema is also observed, as more water is forced out of the blood and into the tissues. In the worst cases, the kidney can no longer contribute its output to sustain the patient’s life, so the patient must undergo dialysis or even receive a new kidney transplant.
When should you go to the doctor?
Since a ureteral stone is usually associated with severe pain and with other unpleasant symptoms, a doctor should always be consulted. The visit to the doctor is necessary when the patient suffers from severe pain during urination. This pain is burning or stabbing and can have a very negative impact on the quality of life of the affected person. Pain in the kidneys or flanks may also indicate a ureteral stone and should be investigated. Often there is also a red coloration of the urine due to blood admixture. Nausea may also indicate a ureteral stone and should always be investigated if it occurs with pain during urination. If the ureteral stone is not treated, kidney damage can occur in the worst case. A ureteral stone is treated by a urologist. Early diagnosis can quickly lead to a positive course of the disease without complications. In severe cases or if the pain is very severe, the hospital may also be visited.
Treatment and therapy
Colicky pain associated with a ureteral stone can be treated symptomatically with analgesic or antispasmodic medications; such analgesics can be injected into an affected person’s vein, for example. If a ureteral stone does not go away on its own or with the help of the supply of large quantities of fluid, in some cases special medications lead to the stone going away. Further treatment options are to break up a large ureteral stone using various procedures. The resulting smaller pieces of the ureteral stone then usually pass away on their own. In the case of a ureteral stone that is no larger than about 2.5 centimeters, appropriate external disintegration can usually be performed using ultrasound waves. If this procedure is not possible, there are several other methods of disintegration available, which involve inserting devices into the ureter. If the above procedures remain successful or are not possible, a final therapeutic step is to remove the ureteral stone with the help of surgery.
Outlook and prognosis
The prognosis of a ureteral stone is favorable. In most patients, spontaneous healing can be documented, since in them, the lodged substances in the body dissolve on their own and are removed. Treatment is not always necessary due to the described possibility. The targeted supply of fluids can already bring about a dissolution of a ureteral stone and thus initiate recovery. The deposited crystals can develop different sizes. These are responsible for the occurrence of possible complications. In severe cases, pain and inflammation occur. If the patient has a weakened immune system, healing may be delayed.The inflammation may spread and cause deterioration of the general health. Medical care is necessary so that the organism can provide sufficient defenses. In rare cases, surgical intervention is necessary. The ureteral stone is completely removed and the patient is discharged from the treatment as cured. A new formation of the ureteral stone is possible in the course of life. People with an unhealthy lifestyle are particularly at risk. The prognosis remains good if the symptoms recur. The sooner the foreign body is noticed, the lower the risk of removing it. In the long term, however, a change in eating habits is still recommended to prevent recurrence.
Prevention
To prevent a ureteral stone, medical professionals first advise general prevention options, such as drinking adequate amounts of fluids (about 2 to 4 liters per day) and eating a diet that is not too heavy in salt. Since obese people are more likely to have ureteral stones, preventive weight reduction can be useful. Furthermore, if medically advisable, a ureteral stone can be prevented with medication.
Follow-up care
After urinary stones have been eliminated, follow-up care measures must be decided on an individual basis. Urinary stone disease recurs in about 50 to 70 percent of cases. Regular medical follow-up examinations are therefore necessary. As part of the follow-up examination, the doctor will make a metabolic diagnosis and for this purpose, among other things, take urine samples and perform a physical examination. In the case of chronic conditions, an excreted ureteral stone can be used for analysis. Stone analysis and other basic diagnostic measures are used to determine any health complaints. Typical urine diagnostics are performed using a urine test strip. The physician checks cystine, uric acid and struvi levels, among others. If there are deviations from the norm, medication can be prescribed to prevent the formation of another ureteral stone. In the case of a positive course without chronic conditions, the frequency of follow-up examinations can be reduced. If chronic metabolic disorders are present, a monthly frequency is advisable. The first follow-up examination takes place at the earliest four weeks after the initial treatment of the stone condition. Earlier examination only provides information on the immediate development after therapy, but not on the long-term outlook. The patient should consult other medical professionals as necessary during follow-up. Follow-up care is provided by the patient’s family doctor or a urologist. In the case of chronic diseases, the relevant specialist must also be involved in the follow-up examinations.
What you can do yourself
Ureteral stones should always be treated by a physician. Accompanying medical treatment, various home remedies and self-help measures are available. Those affected should first drink enough – at least three liters per day – and get plenty of exercise. Physical exercise and physiotherapy can usually loosen and flush out the stone quickly. Regular stair climbing is considered a particularly effective measure for ureteral or kidney stones. If this does not have any effect, dietary and nutritional supplements with plenty of magnesium may help. An alternative remedy from nature is dandelion. Taken in the form of tea, the diuretic supports the removal of ureteral stones and also promotes kidney circulation. In addition, a diet low in meat and fat should be taken into account. Above all, calcium, which is contained in milk and dairy products, should be avoided in acute ureteral stones. The same applies to rhubarb, chard, spinach and other foods containing oxalic acid, as well as foods containing too much sugar and salt. If these measures do not have any effect, a doctor should be consulted and the stones should be treated medically. Classic painkillers such as ibuprofen or metamizole, but also natural painkillers from nature help against the pain.
