Ureter is the part of urinary tract that comprise of the tubes connecting kidney in to the bladder. Among various kinds of stones that can occur in urinary tract, one is the Ureter stones. We will talk about the ureter stones in this current article of ours where we will discuss on the symptoms, causes, diagnosis, treatments and preventive measures for the same.
Overview on Ureter Stones:
Our urinary tract mainly comprises of the kidney, the ureter, and bladder. Depending on the location of the stones in the urinary tract, they can be named as the Kidney stones, ureter stones etc. In the following arrays of our article we will talk about the ureter stones.
The kidney stones or the pieces of kidney stones leave the kidney and travel via ureter to the bladder. These stones are made of salts and minerals in the urine that stick together so as to form small “pebbles.” These stones while they are at the kidney may remain painless; but as they travel to the bladder via the narrow tubes of the ureter; they cause severe pain. Some kidney stones pass through the ureter, reach the bladder and may move out of the body with urine. However, sometimes some stones get lodged in the ureter which can block the flow of urine from the kidney and generate pain. These are the ureter stones.
There may be various symptoms experienced with the kidney or the ureter stones which we will look on our following paragraphs.
Symptoms of Ureter Stones:
Below are some of the symptoms of ureter stones we can take a look at.
- Severe pain, especially in the back and the side, mostly below the ribs
- Pain while passing urine
- Pain that changes locations or changes in intensity, etc.
- Nausea and vomiting may also be symptoms of ureter stones
- Frequent urination can be a symptom for ureter stones
- One more symptom of ureter stone may be blood in urine
- There may be a cloudy or strong foul smell in urine.
- Sometimes patients with ureter stones or the kidney stones may also have severe fever and chills. This usually happens when there is an infection along with the stones.
Symptoms to Check in Ureter Stones:
It is essential for us to have a check on the symptoms, to know when to call the doctor. Below are some of the symptoms in ureter stones which demand a doctor’s visit on immediate basis.
- If you find blood in urine
- If there is difficulty while urinating
- If there is severe pain that makes it difficult for you to find a comfortable position
- Pain along with the symptoms like fever, chills, nausea, vomiting etc.
Types of Ureter Stones:
There are various types or ureter stones and they are basically categorized in to four primary types namely; Calcium Stones, Uric Acid Stones, Cystine Stones, and Struvite Stones.
- Calcium Stones: About 80% of the kidney or ureter stones are calcium stones. These are composed of calcium. Having too much of calcium in the urine can cause calcium stones. There are two types of calcium stones which include calcium oxalte stones and calcium phosphate stones.
- Uric Acid Stones: These types of ureter stones comprises about 5-10% of the stones. These are formed by uric acid crystals that do not dissolve well in acidic urine. Uric acid is actually a waste product that comes from chemical changes in the body. Type 2 diabetes, chronic diarrhea, overweight, gout etc. are some of the causes for uric acid stones in ureter
- Struvite Stones: About 10% of the ureter stones or kidney stones or the urinary tract stones are struvite stones. These stones are linked to chronic urinary tract infections or UTIs. Magnesium ammonium phosphate or Struvite stones form in alkaline urine. These struvit stones are often large, with branches and they often grow at a very quick rate.
- Cystine Stones: About 1% of the ureter stones are cystine stones. Cystine is actually an amino acid that is in some specific foods. Too much cystine in urine can cause cystine stones. Such type of ureter stones or urinary tract stones starts from childhood.
Causes of Ureter Stones:
Now, we know that ureter stones are mostly the kidney stones or the pieces of kidney stones that have accumulated at the ureter while travelling through it to bladder. We also know that some ureter stone pass out of the body via urine. However those which accumulate or stay in the ureter, make it difficult for the urine to pass out and cause severe pain. Now, let us take a look on the causes of ureter stones or the kidney stones.
- There may be stones formed in ureter or kidney or the urinary tract as a whole when the urine gets too saturated with salts that form stones.
- Stones are also formed because the urine lacks the normal inhibitors of stone formation. Citrate is one such inhibitor which binds with calcium that is most often involved in stone formation.
- Lack of enough fluids in body can cause ureter stones. If you are not taking plenty of water then the substances in urine are more likely to stick together and produce stones.
- There are risks of stones formation in overweight people.
- Certain medical conditions like inflammatory bowel disease and gout may affect the normal balance of urine and lead to ureter or kidney stones.
- Rarely some hormonal imbalance may cause ureter stones.
- Kidney stones or the ureter or urinary tract stones may also have hereditary causes.
Diagnosis for Ureter Stones:
Now, let us come down to the diagnosis part of ureter stones here. Doctors suspect stones through some physical examinations which may include tenderness over the back and groin portion or with the pain in the genital area. Apart from this, physical symptoms like blood in urine support the diagnosis of stones. Some of the tests and diagnosis procedures which help in diagnosis of ureter stones include the following.
Helical or Spiral Computed Tomography:
This is usually the best diagnostic procedure which is done without using the radiopaque contrast material. It can locate a stone and also indicate the level to which the stone is blocking the urinary tract. Helical or spiral computed tomography can also detect many other disorders. However, the major disadvantage of this diagnosis procedure is that it exposes people to radiation. Still this procedure is more popular. There are many newer devices and methods that limit the level of radiation exposure to people now.
Ultrasonography is one of the alternative diagnostic procedures to Computed tomography and this procedure does not expose people to radiation. However there are disadvantages of this procedure as it more often misses small stones, especially the small ureter stones.
One more procedure to diagnose the ureter stone or urinary tract stones is the Excretory urography. It is a procedure where a series of X-rays are taken after intravenous injection of a radiopaque dye. This diagnosis test can detect stones and also accurately determine the degree to which they are blocking the ureter or the urinary tract. However it is time consuming and also involves the risk of exposure to the dye.
X-rays also help in detecting ureter stones. However they can only detect the calcium stones. This procedure can be used to know about the stones in the ureter or how far the kidney stones reached in the ureter.
Urinalysis is one more diagnosis procedure used to find out ureter stones. This is usually done as it may show blood or pus in the urine, whether or not the symptoms are present.
Treatments for Ureter Stones:
So now that we are known to the diagnosis of ureter stones, let us take a look on some of the treatment procedures here.
- Medicines as treatments for relieving pain: Non steroidal anti-inflammatory drugs or the Opiods can be taken for relieving pain due to ureter stones. Painkillers can be taken to relieve pain cause due to ureter stones or the kidney or urinary tract stones. However, smaller stones do not require any treatments as they usually pass out of the body via urine. There are some medicines like nephedipine and temsulosin etc, where the smaller stones are made to pass out easily. Some bigger stones require treatments other than the OTC medicines or pain killers. They are needed to be treated with various kinds of stone removal therapies we will discuss below.
- Treatments for Ureter Stone Removal: In order to treat the larger ureter stones; we need to go for the stone removal therapies. There are various types of the stone removal therapy which can be followed so as to remove the ureter stones out of the body and relieve the symptoms. Let us see below the types of stone removal therapies.
Ureter Stone Removal Via Dissolving the Stones:
There are also procedures to dissolve the stones, especially the uric acid stones by making the urine more alkaline. For example, taking potassium citrate for about 6 months orally, can help you turn the urine alkaline and help in dissolving uric acid stones.
Ureter Stone Removal Via Small Incisions:
Here we will talk about the stone removal processes where small incisions are made so as to remove the ureter stones.
- Shock Wave Lithotripsy for Ureter Stone Removal:
Shock wave lithotripsy is a process which can be used to break up a stone in the uppermost part of the ureter that is half an inch or lesser in diameter. Here in this case, shock waves are directed at the body by a sound wave generator that breaks up the stone. Then the pieces of stones are passed in the urine.
- Holmium Laser Lithotripsy:
This is the treatment procedure to remove stones by using a laser that is used to break the stones up. This is also a popular therapy for stone removal.
- Stone removal via a ureteroscope:
One more procedure to remove stones can be with the use of a ureteroscope or a kind or endoscope that can be inserted in to the urethra, and through the bladder so as to remove small stones, especially stone present in the lower portion of the ureter that requires to be removed out of the body.
- Introcorporeal Lithotripsy:
In some cases, ureteroscope is also used to break up the stones in to smaller pieces so that they may pass out in urine. This procedure is termed as Intracorporeal lithotripsy.
- Percutaneous Nephrolithotomy:
This is a therapy used to remove the larger ureter stones or the urinary tract stones that are larger in size. In this procedure, a small incision is made in the patient’s back and then a nephroscope or a kind of endoscope is inserted in to the ureter, or the kidney. Doctors here insert a probe via the nephroscope that helps in breaking the larger stones in to smaller pieces and then remove the pieces out.
Stone Removal Via Surgery:
In this process of treating ureter stone or removing the stones; there is a requirement for undergoing surgery. Usually surgical removals of ureter stones are essential for very large stones that may cause an obstruction. Endoscopic surgery is usually performed for removing stuvite stones. Here antibiotics are not that helpful for the infections in urinary tract caused by the ureter stones and it requires the removal of the stones for getting rid of the infection.
Prevention Against Ureter Stones:
It is known and recommended to drink a plenty of fluid or water so as to prevent all types of stones. Other preventive measures depend on the types of stones which one may have risk of getting encountered with. Here, let us take a look on some of the preventive measures for ureter stones.
- In case if one is suffering from hypercalciuria where the individual has excess of calcium in the urine and may have risk of developing calcium stones in the ureter, kidney or the urinary tract; he or she must try to decrease the measure of calcium amount in the urine by help of a diet that is low in sodium and high in potassium. Calcium intake in such person should be normal, i.e. about 1000 to 1500 ml a day. Antacids that contain calcium should be avoided. It is also essential to restrict dietary animal protein which may help you reduce urinary calcium and reduce the chances of calcium stone formation in the urinary tract. In order to prevent self from the risk of developing uric acid stones; a diet low in animal sources of protein like poultry, meat, fish etc is recommended. These animal proteins enhance the level of uric acid in the urine. Allopurinol can also be given so as to reduce the production of uric acid. It is essential to drink a lot of water for preventing ureter stone formation.
- Taking plenty of fluid along with alpha-mercaptopropionylglycine or tiopronin can help prevent occurrence of cystine stones; which can keep the cystine level low in the urine.
- People with recurrent stuvite stones, need to taking antibiotics continually so as to prevent the infection of urinary tract.
Now that we are aware of the ureter stones, it is essential for an individual to pay attention to the symptoms and make a doctor’s visit in case of any suspicion. Diagnosing and taking the necessary treatments at an early stage can help you recover soon. It is possible that by taking some preventing actions we can prevent self from being encountered with these stones.