Ureteric Stones
A ureteric stone is a kidney stone that has moved into the tube connecting the kidney to the bladder. Some stones pass without surgery, while others cause persistent pain, obstruction or infection and require active treatment.
Fever or significant illness with an obstructing stone requires urgent assessment
An obstructed urinary system associated with infection can be a urological emergency. Seek urgent medical assessment if stone symptoms occur with fever, chills, significant deterioration, difficulty passing urine or other concerning symptoms.
What is a ureteric stone?
Most ureteric stones begin within the kidney. Once a stone moves out of the kidney, it enters the ureter — the narrow tube carrying urine from the kidney to the bladder.
A stone can temporarily or persistently interfere with urine flow as it travels through the ureter. Pressure can then build within the urinary system and produce the severe intermittent pain commonly known as renal colic.
Stones can be located within the upper, middle or lower ureter. Their size, location and effect on kidney drainage are important when estimating whether spontaneous passage is reasonable or whether active treatment should be considered.
Start with the main Kidney Stones guide
Three questions shape most ureteric stone decisions
Treatment is not selected from stone size alone. Location and the effect the stone is having on the urinary system can be equally important.
How large is it?
Smaller stones generally have a greater chance of spontaneous passage. Increasing stone size can make active treatment more relevant.
Where is it?
A stone that has progressed toward the lower ureter and bladder can behave differently from a stone remaining within the upper ureter.
What is it doing?
Pain, persistent obstruction, infection and effects on kidney function can move the balance toward intervention.
Already know the size and location of your stone?
Use the Kidney Stone Treatment Explorer to understand how size, location, obstruction and other factors can influence the discussion around observation, ureteroscopy, shock-wave treatment and other treatment pathways.
What does a ureteric stone feel like?
Symptoms can change as the stone moves from the kidney toward the bladder.
Severe flank pain
Renal colic commonly causes sudden severe pain in the side or back and may fluctuate in waves.
Pain toward the groin
Pain can move toward the lower abdomen, groin or genital region as the stone progresses further down the ureter.
Nausea or vomiting
Significant renal colic frequently causes nausea and can sometimes result in repeated vomiting.
Blood in the urine
Stones can cause visible blood in the urine or microscopic blood identified during urine testing.
Urinary urgency
Stones near the bladder can sometimes produce urinary frequency, urgency or discomfort.
Fever or chills
Fever or significant illness with urinary obstruction raises concern for infection and requires urgent medical assessment.
How is a ureteric stone assessed?
Imaging helps confirm the stone, establish its position and determine whether urine drainage from the kidney is affected.
Depending on the clinical situation, assessment may include CT, ultrasound, urine testing and blood tests. Existing scans are particularly useful when deciding whether observation or active treatment is appropriate.
Can a ureteric stone pass by itself?
Yes. Many ureteric stones can pass naturally. The likelihood is influenced particularly by stone size and how far the stone has travelled down the ureter.
Smaller & lower ureteric stones
Smaller stones and stones that have progressed closer to the bladder generally have a greater likelihood of spontaneous passage, provided observation remains clinically safe.
Larger, persistent or obstructing stones
Active treatment becomes more relevant when spontaneous passage is unlikely, pain remains troublesome, obstruction persists or kidney function is threatened.
When can observation be reasonable?
Observation can be considered when a stone has a reasonable chance of passing and there is no complication requiring more immediate intervention.
- Pain can be adequately controlled
- No significant urinary infection
- No concerning deterioration in kidney function
- No unsafe persistent urinary obstruction
- A reasonable likelihood of stone passage
- Appropriate follow-up can be arranged
Can medication help a ureteric stone pass?
Medical expulsive therapy may be considered for selected ureteric stones when a period of spontaneous passage is appropriate. Suitability depends on the stone, symptoms, contraindications and the overall clinical situation.
What can move the decision toward intervention?
The decision is based on what the stone is doing to the patient and urinary system rather than simply whether a stone is present.
Persistent pain
Recurrent or significant pain despite appropriate initial management can favour active stone treatment.
Persistent obstruction
Continued blockage of kidney drainage can make prolonged observation inappropriate.
Low chance of passage
Larger stones and some stone locations are less likely to clear spontaneously.
Infection
Infection behind an obstructing stone can require urgent drainage rather than waiting for spontaneous passage.
Kidney function
Threatened kidney function, bilateral obstruction or obstruction of a solitary functioning kidney requires particular consideration.
Individual circumstances
Work, travel, anatomy, medical history, access to care and patient priorities can influence treatment timing.
How are ureteric stones treated?
The appropriate pathway depends on stone size and location, symptoms, obstruction, infection risk, kidney function, stone characteristics and individual circumstances.
Observation & spontaneous passage
Selected stones can be allowed time to pass naturally when symptoms are manageable and there is no infection, unsafe obstruction or deterioration in kidney function.
Explore the non-surgical pathwayUreteroscopy & laser stone surgery
A fine telescope is passed through the natural urinary tract to reach the stone. The stone can then be retrieved or fragmented using laser energy where appropriate.
Learn about ureteroscopy & laserShock Wave Lithotripsy
Shock waves generated outside the body can fragment suitable stones. Suitability depends on factors including stone position, size, density, anatomy and the likelihood of fragments clearing.
Explore shock wave lithotripsyUreteric stent or nephrostomy
When an obstructed kidney requires urgent drainage, urine can be diverted using an internal ureteric stent or a nephrostomy. Definitive stone treatment can then be planned when appropriate.
Understand ureteric stentsWhere the stone sits within the ureter matters
The ureter runs from the kidney to the bladder. Stone location can influence symptoms, likelihood of spontaneous passage and which treatment options are technically suitable.
Closer to the kidney
Upper ureteric stones may be considered for ureteroscopy or, in selected circumstances, shock-wave treatment. Impaction and stone characteristics can affect the approach.
Middle ureter
Treatment depends on stone size, symptoms, duration, obstruction and whether the stone continues to progress.
Closer to the bladder
Smaller distal stones can have a greater chance of spontaneous passage, although persistent obstruction or symptoms can still lead to treatment.
Details on the CT scan can change the treatment discussion
These more focused guides cover situations where stone position, impaction, density or infection may materially affect treatment planning.
Impacted Upper Ureteric Stones
Learn why a stone that remains lodged within the upper ureter may require different procedural planning from a freely mobile stone.
Explore impacted stones → CT treatment planningStone Density & Hounsfield Units
CT density provides additional information about a stone and can be relevant when considering treatment options such as shock-wave lithotripsy.
Understand stone density → Urgent stone careBlocked or Infected Kidney Stone
Infection behind an obstructing stone is different from routine elective stone treatment and can require urgent urinary drainage.
Understand infected obstruction →
What happens if an obstructed kidney is infected?
When urinary obstruction occurs together with infection, the immediate priority may be to drain the kidney rather than remove the stone during the acute illness.
Drainage can be achieved using an internal ureteric stent or a nephrostomy tube placed directly into the kidney. Definitive treatment of the stone can then be planned after the infection has been appropriately treated and the patient has recovered.
- Fever or chills
- Rigors or marked systemic illness
- Urinary obstruction
- Deteriorating kidney function
- Difficulty or inability to pass urine
From renal colic to stone clearance
Confirm the stone
Imaging establishes stone size and location and whether urinary obstruction is present.
Assess safety
Pain, infection, kidney function, obstruction and other clinical factors are reviewed.
Observe or treat
Selected stones can be observed while others may require ureteroscopy, SWL or urinary drainage.
Confirm clearance
Follow-up can determine whether the stone and obstruction have resolved and whether further prevention assessment is appropriate.
Will I need a ureteric stent?
Not every ureteric stone procedure requires a stent. A temporary stent may be inserted when additional internal drainage is considered useful before or after stone treatment.
Stents can produce urinary frequency, urgency, bladder discomfort, blood in the urine and sometimes discomfort within the kidney region. Symptoms vary considerably between patients.
The timing and method of stent removal depends on why the stent was inserted and the procedure performed.
Ureteric Stents – What to ExpectLearn about ureteroscopy & laser surgery
Why is a stent inserted?
A stent can help maintain urine drainage when there is obstruction, swelling or another reason temporary internal drainage is helpful.
What can a stent feel like?
Frequency, urgency, bladder discomfort, blood in the urine and intermittent flank discomfort can occur.
Know the removal plan
Temporary stone-related stents require a clear plan for removal, exchange or a subsequent stone procedure.
Have you had ureteric stones more than once?
Treating the current stone does not necessarily address why stones are forming. Recurrent stone formers may benefit from stone analysis, blood testing and specialised urine assessment to identify potentially modifiable risk factors.
Ureteric stone FAQs
Is a ureteric stone different from a kidney stone?
Can a ureteric stone pass by itself?
How long does a ureteric stone take to pass?
Does a larger ureteric stone always need surgery?
What is renal colic?
Can a ureteric stone damage the kidney?
When is a ureteric stone an emergency?
What happens if the stone does not pass?
Will I need a ureteric stent?
How do I know if the stone has actually passed?
Why do I keep getting ureteric stones?
Have you already had a CT scan showing a ureteric stone?
Existing imaging can be reviewed to establish the stone's size and location, whether the kidney remains obstructed and whether observation, ureteroscopy, shock-wave treatment or another pathway may be appropriate.
This information is general educational information and does not replace individual medical advice. Ureteric stone management depends on factors including stone size and location, symptoms, urinary obstruction, infection, kidney function, urinary anatomy, previous treatment, medications and individual clinical circumstances. Seek urgent medical assessment for fever, chills, significant illness, difficulty passing urine or other concerning deterioration associated with suspected urinary obstruction.