Clinical manifestations
The clinical presentation of ureteral stones is similar to that of renal stones.
Prevalent groups
Young adults are the most prevalent group: the peak age of onset is 20-50 years old, which means that they are more likely to occur in the workforce in the prime of life, with men being 2-3 times more likely than women.
Symptoms
(1) Lumbar colic: renal colic is a typical symptom of ureteral calculi, which usually occurs suddenly after exercise or at night with severe pain on one side of the lower back, often described as “knife-like” because it hurts too much, and can be accompanied by pain in the lower abdomen and inner thighs, nausea and vomiting, and pallor. The patient is restless and in great pain. Some patients have vague pain and swelling in the lower back. After the pain, some patients can find stones excreted with urine.
(2) Hematuria: About 80% of patients present with hematuria, only some of which can be detected visually as red urine, most of which can only be detected by laboratory urine tests.
(3) Asymptomatic: Many patients find ureteral stones by chance during physical examination, without any symptoms.
(4) Hydronephrosis: stones block the ureter and cause hydronephrosis due to poor urine drainage. Some hydronephrosis can have no symptoms. Long-term hydronephrosis can cause impaired kidney function on the affected side. Severe bilateral hydronephrosis may lead to uremia.
(5) Fever: Ureteral stones can also induce bacterial infection, leading to pus accumulation in the kidney and high fever. Because the stones obstruct the urinary drainage, bacteria cannot be excreted in time, which can lead to sepsis in severe cases and endanger life.
Examination
Urological X-rays can be used as a preliminary test for ureteral stones, and about 10% of ureteral stones are not visualized. Ultrasound is not a good way to diagnose ureteral stones because most of the ureter is obscured by the intestines and bones, and ultrasound can usually only detect the upper ureteral segment. A definitive diagnosis of ureteral stones relies on CT and intravenous urography (IVU).
Differential diagnosis
When renal colic occurs, it needs to be differentiated from cholecystitis, appendicitis, intestinal obstruction, ureteral stricture, ureteral tumor, etc.; abdominal calcification points need to be differentiated from gallbladder stones, lymph node calcification, renal tuberculosis, pelvic vein stones, etc.
First aid measures
The following cases need to be treated as soon as possible at the hospital for emergency treatment
(1) renal colic: give antispasmodic and analgesic treatment.
(2) Infection with high fever: Give antibiotics and antipyretic treatment, and more importantly, drain the pus from the kidney by placing ureteral stent or nephrostomy as soon as possible.
(3) Anuria: If uremia has occurred and the body is in critical condition, dialysis treatment is required. If the condition is stable, it is also necessary to place a ureteral stent or renal puncture fistula to temporarily drain urine and protect kidney function.
Treatment
Ureteral stones tend to cause ureteral obstruction and should be treated aggressively. Usually, 80% to 90% of ureteral stones smaller than 5mm can be expelled within 6 weeks, so conservative treatment is usually chosen. You can take herbal medicine for stone removal, together with antispasmodic and analgesic drugs and ureteral relaxation drugs. According to the “Guidelines for the Treatment of Ureteral Stones” of the Chinese Medical Association Urology Section, ureteral stones larger than 5 mm can be treated by extracorporeal lithotripsy or ureteroscopic stone extraction. Generally speaking, for stones in the upper ureter, extracorporeal lithotripsy is more effective; for stones in the middle and lower ureter, ureteroscopic stone retrieval is more certain. If the ureteral stones are too large and extracorporeal lithotripsy or ureteroscopic treatment fails, incision for stone extraction is an option. After the treatment, it is important to review the stone so that the stone can be removed.