Your doctor will choose a treatment for your ureter stones based on the size of the stones and how painful the condition is. Your doctor will prescribe watchful waiting if your ureter stones are not causing too much distress. You doctor may choose to break down the ureter stones using lithotripsy (breaking down the stones with shock waves), or your doctor may choose to surgically remove the stones using If your ureter stones are more advanced, our doctor may recommend lithotripsy, or may recommend removing the stones via ureteroscopy or open surgery.

Watchful Waiting

If your ureter stones are less than 7mm in diameter and you are not experiencing extreme pain, your doctor may recommend six weeks of watchful waiting. Watchful waiting is not a passive waiting process; rather, your doctor will monitor the status of your ureter stones using ultrasounds or x-rays during the six week waiting period to make sure the stones are not growing, and that no infection is developing in the urinary tract while you wait for the stones to pass. You will be advised to drink at least three quarts of water a day to help flush the stone out.While this method is the most conservative of ureter stone treatments, patients often experience pain and tenderness during the waiting process. Doctors will typically prescribe an analgesic such as ibuprofen to alleviate your discomfort during this time.

Extracorporeal Shock Wave Lithotripsy

If your ureter stones are large or concentrated, your doctor may recommend using extracorporeal shock wave lithotripsy (ESWL), a minimally invasive treatment which uses shock waves to break ureter stones into smaller pieces, enabling them to be flushed out of the body more easily.

ESWL is administered under general or local anesthesia using an external (extracorporeal) device to generate shock waves. Depending on the location and size of your stones, you may need more than one session to fully breakdown the stones. Although ESWL treatment can be uncomfortable, it is a highly effective treatment for ureter stones; up to 90% of patients pass their kidney stones following ESWL treatment.

Ureteroscopy

If your ureter stone is located lower in the ureter and is less than 10mm in diameter, your doctor may recommend ureteroscopy, a more invasive procedure which uses a ureteroscope (a thin, lighted instrument) to visualize the stones, and a flexible basket to capture and remove the stones. Ureteroscopy is an outpatient treatment performed under general anesthesia; you will likely go home the same day as the procedure. Your doctor will be cautious about possible tears or detachment (avulsion) of the ureter during and after the procedure. You will have a stent placed in the ureter to keep it open following the procedure.

Percutaneous Nephrolithotomy (PNL)

If your ureter stones are small (1-2 cm diameter) and located in the upper ureter (near the kidney), your doctor may opt to perform percutaneous nephrolithotomy (PNL), which uses a thin wire to remove the small stones. Your doctor will access the kidney by making an incision between the ribs and the hip, and then make a small incision in the kidney. A wire will be threaded through the kidney into the ureter, where the wire is dilated, and the ureter stone is removed through the wire. PNL is an invasive procedure which is performed in the hospital under general anesthesia. Side effect may include pain, blood in urine, infection, and sometimes damage to the colon and blood vessels around the kidney.

Open Surgery

Open surgery will be considered if less invasive procedures fail to remove your ureter stones. To perform open surgery your doctor will make an incision in the lower abdomen to access the ureter, and the ureter is cut open so that stone can be directly removed. This is an invasive procedure which will require a 5-7 day stay in the hospital, and up to 6 weeks of recovery time. You may experience pain, swelling, and blood in your urine for several days following the procedure.

Successful treatment of your ureter stones will depend on the type of procedure used. Regardless of the procedure, ureter stone patients have a 50 percent chance of developing another ureter stone within 5 years of treatment. Talk to your doctor about which procedure would most effectively treat your ureter stones.