Ureteral calculi


Ureteral calculi

Description, Causes and Risk Factors:

Ureteral calculi are stones that originated in the kidneys but are found in the ureter. Normal urine contains predictable amounts of calcium, magnesium, uric acid, and other by-products of metabolism. These substances normally remain in solution and pass from the kidneys, down the ureter, into the bladder, and out of the body. When the concentration of these minerals and by-products in urine becomes too high, they form solid crystals on the inner surfaces of the kidneys. Over time, these crystals may accumulate to form small, hard, stone-like particles in the kidneys. Calcium-containing calculi are the most common type of ureteral calculi, comprising 75-80% of all urinary tract stones.

Although the majority of ureteral calculi develop in individuals between the ages of 20-49, the peak age of formation in men is age 30 and in women is age 32, with a second peak at age 55. Hispanics are more prone to develop calculi than African-Americans, Asian-Americans, and Caucasians. A high-protein diet, heredity, or living in hot, dry regions also increases the risk.

For active treatment to remove ureteral calculi, there are four treatment choices: extracorporeal shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy and open surgery.

Symptoms:

Symptoms vary according to the site and size of the stone. Small calculi frequently cause no symptoms until they begin to pass from the kidney into the ureter. The resulting pain (renal colic) often is excruciating and intermittent. Individuals may report pain that starts on the far right or far left side of the back (flank) and then moves toward the groin. Severe pain may precipitate nausea and vomiting. This can then result in significant dehydration. Bloody urine (hematuria) occurs in 90% of cases. Cloudy or foul-smelling urine also may be noted, as may fever, chills, and frequent urination. If the urethra is blocked, the individual may report being unable to urinate.

Diagnosis:

The doctor will use diagnostic imaging to con?rm that a stone is causing the patient's symptoms. The imaging will include x-rays and possibly a sonogram. These images will not only show thestone's location, but help the doctor determine itssize and shape.

Labs: Blood and urine samples will beanalyzed for signs of infection and to help identify the stone's chemical composition.

Treatment:

The major goal for treating patients with ureteral calculi is a stone-free state. The optimal therapy for patients requiring removal of distal ureteral calculi is controversial. Shock wave lithotripsy (SWL) and ureteroscopy are both effective treatments associated with high success rates and limited morbidity. Women of childbearing-age have been historically excluded from SWL of middle and distal ureteral calculi because it was thought that the effect of shock wave energy on the ovary might be deleterious.

If ureteral calculi are caused by a metabolic disorder, the individual may be treated with changes in diet and with drugs to lower the urine content of the substance from which the calculi are formed. Increased fluid intake may be necessary to help dissolve existing calculi and reduce the chance of recurrence.

Open Surgery: In open surgery for ureteral stones, the doctor makes a surgical cut to expose the ureter where the stone is located. Another cut is made in the ureter itself, and the stone is directly removed. Open surgery is the most invasive treatment. It is usually reserved for complicated, difficult cases. Most patients need about six weeks to recover after the operation.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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