Ureteric Calculi - Types, Causes, Symptoms, Diagnosis, and Treatment

Introduction

Ureters are two thin tubes connecting the kidneys with the urinary bladder. These carry urine from the kidneys to the urinary bladder, where the urine is stored until the urge to urinate. Ureteric calculi are asymmetrical, hard deposits of salt and minerals formed within the ureters.

Ureteric calculi or stones can be found in either the left or right ureter. The ureters are around ten to twelve inches long. The calculi can be found at the point of origin or farther away from the origin of the ureter. The small ureteric calculi are usually asymptomatic, while the larger ones can block the urine flow and cause severe pain.

What Are the Different Types of Ureteric Calculi?

Ureteric calculi are of four different types:

• Calcium Calculi: These are the most common types of calculi. Calcium oxalate and calcium phosphate are the most common types of calcium stones.

• Uric Acid Calculi: Excessive uric acid in the urine can lead to the formation of uric acid stones.

• Struvite Calculi: Struvite calculi are made of magnesium ammonium phosphate and calcium-apatite. It is usually formed after an episode of urinary tract infection.

• Cystine Calculi: Cystine stones are usually formed due to the genetic disorder cystinuria. Cystinuria causes the amino acid cystine to move out of the body through the urine.

What Causes the Formation of Ureteric Calculi?

Ureteric stones are formed when there is an excess of salt and minerals in the body. Usually, these minerals and salts are flushed out of the body via urine. Still, when they are in excess or if the urine production is less due to dehydration, they deposit and begin to crystallize, thus forming stones. The various types of substances that cause the formation of ureteric calculi are:

• Calcium.

• Oxalate.

• Uric Acid.

• Phosphate.

• Cystine.

• Xanthine.

What Are the Symptoms of Ureteric Calculi?

The small calculi or stones usually pass out of the urine and are asymptomatic. However, the larger ones that block the ureters reduce urine flow, causing various symptoms, such as:

Severe pain in the upper flank, back, or under the ribs. The pain is intermittent; it comes and goes on its own.

• Pain radiating to the lower abdomen.

• Pain and burning while passing urine.

• Nausea and vomiting.

• Hematuria (a condition where there is a presence of blood in the urine).

• Cloudy urine.

• Increased frequency of urination.

• Passing urine in lesser quantities.

Who Is at Risk of Developing Ureteric Calculi?

Anyone can develop ureteric calculus, but there are specific criteria that make one prone to it:

Males are more likely to develop a stone as compared to females.

• A person between the age group of forty to sixty years.

• A person has a history of ureteral calculi.

• A positive family history of ureteral calculi.

• Not taking enough water.

• Diabetes.

• Polycystic kidney disease (a congenital disorder wherein groups of cysts - a fluid-filled pouch develop within the kidneys, causing them to enlarge and impair their ability to function correctly).

How Is Ureteric Calculi Diagnosed?

Tests carried out to diagnose ureteric calculi are:

• Urinalysis - A urinalysis is done to detect signs of infection and the level of certain substances in the urine that might cause stones.

• Blood Test: Blood tests determine how well the kidneys work, the presence of infection, or other problems that might cause ureteral stones.

• Ultrasound: An ultrasound uses sound waves to detect any blockage in the ureters.

• Computed Tomography (CT) Scan: A CT scan uses a combination of X-rays and computer technology to detect the stones' size, shape, and location.

How Are Ureteric Calculi Treated?

Removal of ureteral calculi depends upon the size and location of the stones. It also depends on the composition of the stones. The following treatment modalities are recommended in case of a large stone blocking the ureters:

Shock Wave Lithotripsy: This procedure uses high-energy sound waves to break up the stones in the ureters. The smaller pieces of stone can flush out of the urinary tract with urine. Shock wave lithotripsy is a minimally invasive treatment option.

Ureteroscopy: Ureteroscopy is a procedure in which a urologist inserts a long, thin tube with a camera known as the ureteroscope into the urethra. Once the stone is detected, it is broken with the help of a laser and removed.

Percutaneous Nephrolithotomy: In percutaneous nephrolithotomy, the urologist inserts a scope directly in the kidney through a small incision at the back to locate and remove the stones. The procedure is recommended if the stone is large or irregular.

Ureteral Stents: Ureteral stents are thin, flexible, temporary tubes inserted in the ureters to keep them open, thus allowing the free flow of urine around a stone blocking the way.

Medical Expulsive Therapy (MET) - Medical expulsive therapy effectively treats small distal ureteral stones. Treatments are done with alpha-blockers, calcium channel blockers, corticosteroids, and phosphodiesterase-5 inhibitors (PDE5).

1. Calcium Stones

• Potassium Citrate: This medication makes the urine alkaline and less acidic.

• Diuretics: Diuretics are drugs that help to remove excess fluid and calcium from the body with urine.

2. Struvite Stones

• Antibiotics: These medications help to treat bacterial infections.

• Acetohydroxamic Acid: This medication helps to prevent ammonia buildup in the urine.

3. Cystine Stones

• Tiopronin: This drug helps to prevent stones in people with cystinuria.

• Potassium Citrate - This is a potassium salt of citric acid used to treat ureteric and kidney stones.

How To Prevent Ureteric Calculi?

Ureteric calculi can be prevented by:

• Drinking More Fluids - One should drink around eight to ten glasses of water every day.

• Limiting Protein-Rich Diet - Protein such as meat, eggs, and fish should be reduced to keep a check of uric acid in urine.

• Reduce the Amount of Sodium in the Diet - A low-sodium diet helps to reduce the chance of developing ureteral stones. Oxalate is found in spinach, almonds, cashews, and potatoes. In addition, foods rich in calcium can help the crystallization of oxalate.

Conclusion

Ureteral calculi are hard deposits of salt and minerals in the ureters. Various factors can cause it. However, it is not a lethal condition and can be treated. It can be prevented by drinking enough fluids, limiting protein-rich foods, and reducing sodium and oxalate in the diet. The healthcare provider should be contacted if experiencing pain in the lower abdomen or getting blood in the urine.