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Abstract: Ureteral stones often have back pain, abdominal pain, and nausea as the primary symptoms, with hematuria as a secondary symptom, and are a type of upper urinary tract stone. In some patients, if only hematuria is present, the stones are often small and can be easily missed and misdiagnosed. As in this case, the patient had hematuria for 1 month, during which a urinary ultrasound was performed and the results suggested normal, so he came to the hospital because he was worried. After urological CT examination, ureteral stones were clearly identified and medication was given. After treatment, the ureteral stones were discharged and the symptoms disappeared with good results.
Basic information】Male, 35 years old
Disease Type】Ureteral stones
Hospital】Zhengzhou First People’s Hospital
Date of Consultation】September 2021
Treatment plan】Medication (lithotripsy granules) + daily behavior (drinking more water)
Treatment Period】12 days of outpatient treatment, review after 1 week
Treatment effect】Ureteral stones discharged, symptoms disappeared, good results
I. Initial consultation
One day in September 2021, a college friend called me and said that his cousin had hematuria for one month and had urological ultrasound at a nearby hospital three times, and each time the ultrasound results were normal, with no hydronephrosis in the kidneys and no dilatation of the ureter. He wanted to see the doctor again to confirm if it was abnormal. The next day, the patient came to the clinic, a 35-year-old male with a fat body and a small amount of smoking and drinking. The patient reported no recent medications, no underlying diseases such as hypertension and diabetes, no history of surgery, no history of trauma, no history of urinary stones, no symptoms such as back pain, abdominal pain, urinary frequency, urinary urgency, urinary pain, fever, and nausea. There was only recurrent carnal hematuria with occasional blood clots. Ultrasound was performed in a nearby tertiary care hospital, which showed normal urinary tract and significantly elevated red blood cell count in urine routine. After a brief communication with the patient, physical examination was started, which revealed no pressure pain or percussion pain in both kidney areas, no pressure pain in the suprapubic bladder area, normal genital development, and no abnormal urethral opening. The patient was then advised to further examine and clarify the diagnosis.
II. Treatment history
The patient underwent another ultrasound examination, and still no urinary abnormality was found. CT examination of the urinary tract revealed a stone of about 4 mm in size at the end of the left ureter, no hydronephrosis, and no dilatation of the ureter. The diagnosis was then made: ureteral stone. Considering that the patient had no hydronephrosis, hematuria was not heavy, and the ureteral stone was found for the first time, and the stone was small, there was no urgent need to treat the stone at present, and there was a higher chance of self-discharge. However, there are many uncertainties about the effect of conservative treatment, and the ureteral stones may not be expelled for a long time. After communicating with the patient, we adopted the option of conservative treatment and self-discharge, and then considered surgery if the stone was not discharged within 1 month, or if hydronephrosis appeared and continued to worsen during the review. The patient was then given oral lithotripsy pellets and other lithotripsy drugs for 1 week, during which the patient was advised to drink more water and be more active to promote lithotripsy. 1 week later, the urological CT was repeated and showed that the stone was still not discharged, there was no hydronephrosis in the kidney, and the ureter was not dilated, so it was recommended to continue the conservative treatment for 1 week. 5 days later, the patient reported that he had no hematuria symptoms for 3 days and asked for a repeat CT, which showed that the ureteral stone had been discharged, and the treatment was finished.
III. Treatment effect
After 12 days of conservative treatment, the patient took oral lithotripsy medication and drank more water at home, and the stone was not discharged on re-examination 1 week after treatment; the treatment was continued for 1 week, and on re-examination on the 12th day after treatment, the CT results showed that the ureteral stone was discharged and the patient’s hematuria symptoms disappeared, with good results. However, urinary stones are prone to recurrence, and some stones do not cause symptoms, which patients tend to ignore, so patients are advised to have long-term review and follow-up.
IV. Notes
We are really happy that the patient recovered from the disease, but ureteral stones are usually mainly caused by kidney stones falling into the ureter, the ureter itself does not produce stones and is not easy to detect. Therefore, if the patient has symptoms of hematuria again, he should promptly communicate with the doctor and follow up regularly. In addition, the best preventive measures for ureteral stones are to drink more water to keep more urine to flush the urinary system, to be more active to promote the discharge of stones, and to pay attention to a balanced diet with more fruits and coarse grains to reduce the intake of high cholesterol and high fat foods.
V. Personal insight
Ureteral stones are a kind of upper urinary tract stones, which often manifest as back pain, abdominal pain, nausea, vomiting, hematuria, etc. These stones are small and not easily detected by ultrasound, but hydronephrosis and ureteral dilatation can be found in more than 95% of patients in ultrasound. This case reminds that although ureteral stones basically block the ureter and cause obstruction, so the diagnosis usually relies on the sudden onset of back pain symptoms or the finding of hydronephrosis in color ultrasound for clarity. However, it should be noted that if the stone is small and adheres to the ureteral wall due to inflammatory stimulation, it may not cause obstruction, and there is no hydronephrosis or low back pain.