The vast majority of ureteral stones originate in the kidney, including those caused by kidney stones or by the landing of stone fragments after extracorporeal shock waves. Primary ureteral stones are rare because urine salt crystals are more likely to be excreted into the bladder with urine. Urinary retention and infection can contribute to the development of ureteral stones in the presence of predisposing factors such as ureteral strictures, diverticula, and foreign bodies. Most of the ureteral stones are single, and the onset is similar on the left and right side, with bilateral ureteral stones accounting for about 2-6%. They are most common in young adults, with the highest incidence between 20 and 40 years of age, and the male to female ratio is 4.5:1. The most stones are located in the lower ureter, accounting for about 50-60%. Ureteral stones can cause obstruction and dilatation of the ureteral flow and endanger the kidney, and in severe cases, the kidney function can be gradually lost. Clinical manifestations The symptoms of ureteral stones and kidney stones are basically similar. The size of the stone is not necessarily proportional to the degree of obstruction, hematuria and pain. Stones in the middle or upper part of the ureter that are embedded and blocked or that are in the process of moving down the ureter often cause typical renal colic and microscopic hematuria on the affected side. The pain may radiate to the inner thighs, testes or labia. It is often accompanied by nausea and vomiting, and sometimes the hematuria is visible to the naked eye. The segment between the walls of the ureteral bladder is the narrowest, and stones can easily lodge. Since the muscles of the lower ureter are connected to the bladder triangle and are directly attached to the posterior urethra, the characteristic symptoms of frequency, urgency and painful urination are often present. In larger stones that do not interfere with the passage of urine, there may be only vague pain and light hematuria. Acute anuria and even renal insufficiency can occur in cases such as ureteral stone obstruction in an isolated kidney or bilateral ureteral obstruction, or reflex anuria occurring on the opposite side due to ureteral stone obstruction on one side. History and physical examination Pain and hematuria associated with activity can help establish the diagnosis of this disease, especially with typical renal colic. In taking a history, it is important to ask about the first attack, to confirm the pain attack and the site of its radiation, and to confirm any previous history of stones or family history, including past medical history of genitourinary diseases or anatomical abnormalities, or factors influencing stone formation. Physical examination is mainly to exclude other diseases that can cause abdominal pain such as acute appendicitis, ectopic pregnancy, ovarian cyst torsion, acute cholecystitis, cholelithiasis, pyelonephritis, etc. Percussion pain in the kidney area may be present during the onset of pain. Laboratory diagnosis Routine urinalysis often reveals visual or microscopic hematuria. Pus urine is present in the presence of infection. Sometimes crystalloid urine can be found. Urine bacterial cultures are positive in patients with infected urinary calculi. When I clinically suspect that the patient’s urinary stones are related to metabolic status, blood and urine calcium, phosphorus, uric acid, oxalic acid, etc. should be measured, and if necessary, a calcium loading test should be performed. In addition, renal function should be measured. Imaging diagnosis Ureteral stones (1) Ultrasound: It can show the special acoustic shadow of stones, and also evaluate the renal mass or renal parenchymal atrophy caused by hydronephrosis, etc. It can detect small stones and X-ray translucent stones that cannot be shown by plain radiographs of the urinary tract. Allergy to contrast agent, pregnant women, anuria or renal insufficiency cannot be excreted ah urography, and ultrasound can be used as a diagnostic method. In addition, it can be used to guide percutaneous interventional nephrostomy or to guide the path of percutaneous nephrological diagnosis and treatment. (2) X-ray examination: The purpose is to determine the presence, characteristics and anatomical pattern of the stone, to determine whether treatment is needed and to determine the appropriate treatment. (1) Urological plain radiographs can detect stones above 959,6. Frontal and lateral views can exclude other calcified intra-abdominal shadows such as gallbladder stones, mesenteric lymph node calcifications, and venous stones. Lateral views show upper urinary tract stones behind the anterior border of the vertebral body and intra-abdominal calcified shadows in front of the vertebral body. Stones that are too small or not highly calcified, pure uric acid stones and stromal stones are not shown. ② Excretory urography allows evaluation of structural and functional changes in the kidney due to stones and the presence of urinary tract abnormalities such as congenital malformations that cause stones. If there is a filling defect, it suggests the possibility of x-ray transillumination of uric acid stones. If anatomical abnormalities of the renal pelvis, pelvic ureteral junction and ureter are identified it helps to determine the treatment plan. (iii) Retrograde pyelography is rarely used in the initial diagnostic phase and is often employed when the site of the stone cannot be determined by other methods or when the condition of the urinary tract system below the stone is unknown. ④Planar CT is rarely used as the diagnostic method of choice for patients with stones and can detect stones in the middle or lower ureter that cannot be revealed by the above tests or are smaller. It helps to identify opaque stones, tumors, blood clots, etc., as well as to understand the presence of renal malformations. In addition, bone radiographs should be performed when hyperparathyroidism is suspected. (3) Radionuclide renal imaging: to evaluate the renal function of the kidney damaged before treatment and the restoration of renal function after treatment: to identify the better functioning kidney in patients with bilateral urinary tract obstruction. (4) Endoscopy: including nephroscopy, ureteroscopy and cystoscopy. Usually, when the urological plain film does not show stones and the excretory urography has filling defects and the diagnosis cannot be confirmed, the diagnosis can be clarified and treatment can be performed with the help of endoscopy. Treatment Treatment of ureteral stones includes symptomatic treatment, herbal treatment, extracorporeal shock wave lithotripsy with transendoscopic stone extraction, and surgical stone extraction.