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 kidney associated with urinary infection can be a urological emergency. Seek urgent medical care if stone symptoms are accompanied by fever, chills, significant illness, inability to pass urine or other concerning deterioration.
What is a ureteric stone?
Most ureteric stones begin within the kidney. When a stone moves out of the kidney, it enters the ureter — the narrow tube that carries urine from the kidney to the bladder.
A stone can temporarily block urine flow as it travels down the ureter. This can increase pressure within the urinary system and produce the severe intermittent pain known as renal colic.
Stones can occur in the upper, middle or lower part of the ureter. Their size and location influence the likelihood that they will pass without a procedure.
What does a ureteric stone feel like?
Symptoms can change as a stone travels from the kidney toward the bladder.
Severe Flank Pain
Renal colic often causes sudden severe pain in the side or back and may occur in waves.
Pain Toward the Groin
Pain can move toward the lower abdomen, groin or genital region as the stone moves further down the ureter.
Nausea or Vomiting
Severe renal colic can be associated with significant nausea and vomiting.
Blood in the Urine
Stones can cause visible or microscopic blood in the urine.
Urinary Urgency
Stones near the bladder can sometimes cause urinary urgency, frequency or discomfort.
Fever or Chills
Fever or significant illness with urinary obstruction is concerning for infection and requires urgent medical assessment.
How is a ureteric stone diagnosed?
Imaging is used to confirm the presence and location of a stone and determine whether it is obstructing the kidney.
Depending on the clinical situation, assessment may include CT, ultrasound, urine testing and blood tests.
- Stone size
- Upper, middle or lower ureteric location
- Degree of urinary obstruction
- Kidney function
- Evidence of urinary infection
- Other kidney stones
- Previous stone episodes
Can a ureteric stone pass by itself?
Yes. Many smaller ureteric stones pass naturally, although the chance of spontaneous passage generally decreases as stone size increases.
Smaller & Lower Stones
Smaller stones and stones that have travelled closer to the bladder generally have a greater likelihood of spontaneous passage.
Larger, Persistent or Obstructing Stones
Active treatment becomes more relevant when spontaneous passage is unlikely, pain persists, obstruction continues or kidney function is at risk.
When can a ureteric stone be observed?
Observation can be appropriate for selected patients when the stone has a reasonable chance of passing and there are no complications requiring active treatment.
During this period, symptoms and kidney drainage need to be considered and follow-up may be required to confirm that the stone has passed.
- Pain can be adequately controlled
- No significant urinary infection
- No concerning deterioration in kidney function
- No persistent clinically significant obstruction
- The stone has a reasonable chance of passage
When does a ureteric stone need intervention?
Treatment decisions depend on the stone itself and the effect it is having on the urinary system.
Persistent Pain
Ongoing or recurrent significant pain despite appropriate pain management can favour active treatment.
Persistent Obstruction
A stone continuing to obstruct kidney drainage may require intervention rather than prolonged observation.
Low Chance of Passage
Larger stones or stones that are unlikely to pass naturally may be better managed with active stone treatment.
Infection
Infection associated with an obstructed kidney can require urgent drainage before definitive stone treatment.
Kidney Function
Threatened kidney function, bilateral obstruction or obstruction of a solitary functioning kidney requires particular consideration.
Individual Circumstances
Work, travel, medical conditions, anatomy and patient priorities can also influence treatment planning.
How are ureteric stones treated?
The treatment pathway depends on the size and location of the stone, symptoms, obstruction, infection and individual circumstances.
Observation & Spontaneous Passage
Selected stones can be allowed time to pass naturally when symptoms are manageable and there is no infection, concerning obstruction or deterioration in kidney function.
Ureteroscopy & Laser Surgery
A fine telescope is passed through the urinary tract to reach the stone. The stone can then be removed or fragmented using laser energy where appropriate.
Learn about ureteroscopy & laserShock Wave Lithotripsy
External shock waves can be used to fragment selected ureteric stones. Suitability depends on factors such as stone location, size, density and patient anatomy.
Ureteric Stent or Nephrostomy
When urgent drainage of an obstructed kidney is required, a ureteric stent or nephrostomy can be used to allow urine to drain. Definitive treatment of the stone may occur later.
What if my ureteric stone does not pass?
Ureteroscopy is a common active treatment for ureteric stones. A fine telescope is passed through the urethra and bladder into the ureter so that the stone can be seen directly.
Depending on the stone, it may be removed using a small basket or fragmented with laser energy. A temporary ureteric stent may sometimes be placed after the procedure.
Learn About Ureteroscopy & Laser Surgery
What happens if an obstructed kidney is infected?
When urinary obstruction occurs together with infection, the priority may be to drain the kidney rather than immediately remove the stone.
Drainage can be achieved with an internal ureteric stent or a nephrostomy tube placed directly into the kidney.
Definitive stone treatment is generally planned after the infection has been appropriately treated and the patient has recovered.
From renal colic to stone clearance
Confirm the Stone
Imaging establishes the size and location of the stone and whether urinary obstruction is present.
Assess Safety
Pain, infection, kidney function and the degree of obstruction are considered.
Observe or Treat
Selected stones can be observed, while others may require ureteroscopy, shock-wave treatment or urinary drainage.
Reduce Future Risk
Recurrent stone formers may benefit from stone analysis and further metabolic assessment.
Have you had ureteric stones more than once?
Treating the current ureteric 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.
Explore Recurrent Stones & PreventionUreteric Stone FAQs
Is a ureteric stone different from a kidney stone?
A ureteric stone usually begins as a kidney stone. Once it moves from the kidney into the tube connecting the kidney to the bladder, it is called a ureteric stone.
Can a ureteric stone pass by itself?
Yes. Many smaller ureteric stones pass without surgery. The chance of passage depends particularly on stone size and location and generally decreases as stones become larger.
How long does a ureteric stone take to pass?
Passage time varies substantially. Some stones pass within days, while others can take several weeks. Ongoing observation is only appropriate when complications such as infection, uncontrolled pain or deterioration in kidney function are not developing.
Does a larger ureteric stone always need surgery?
Not automatically. Size is important because larger stones are less likely to pass naturally, but stone location, symptoms, obstruction, infection, kidney function and individual circumstances also affect the decision.
What is renal colic?
Renal colic is the severe pain commonly caused when a ureteric stone obstructs urine drainage and increases pressure within the urinary tract. The pain can occur in waves and may move toward the lower abdomen or groin.
Can a ureteric stone damage the kidney?
Persistent urinary obstruction can affect kidney function, particularly in certain clinical circumstances. This is one reason obstruction and kidney function are considered when deciding whether a stone can safely be observed.
When is a ureteric stone an emergency?
An obstructed kidney with signs of urinary infection can be a urological emergency. Fever, chills, significant illness or inability to pass urine should prompt urgent medical assessment.
What is the treatment if the stone does not pass?
Treatment depends on the stone. Ureteroscopy and laser treatment is a common option, while shock-wave lithotripsy may be suitable for selected stones. Urgent urinary drainage may be needed when obstruction is associated with infection or other complications.
Will I need a ureteric stent?
Not every patient requires a stent. A temporary stent may be used to maintain drainage before or after stone treatment depending on the clinical situation and what occurs during surgery.
How do I know if the stone has actually passed?
Symptoms settling does not always prove that a stone has passed. Depending on the circumstances, follow-up imaging may be recommended to confirm stone passage and that obstruction has resolved.
Why do I keep getting ureteric stones?
Recurrent ureteric stones usually reflect an underlying tendency to form stones within the kidney. Selected recurrent stone formers may benefit from stone analysis and metabolic investigation to identify potentially modifiable risk factors.
Have you been diagnosed with a stone in your ureter?
Existing imaging can be reviewed to assess the size and location of the stone, whether the kidney is obstructed and whether observation or active treatment 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, obstruction, infection, kidney function, urinary anatomy and individual clinical circumstances.