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URS - Removal of the ureter stones

Ureter stones. General Information

h9991856_001Kidneys’ function is to remove toxic substances emerging from biochemical reactions in the body and return back normal substances to the blood. Stones are formed as a result of the combination of insoluble and inextricable crystals.

They are mostly observed in the men between 30-60 and occurrence is 3 times more compared to the women. Genetic factors, climate, diet, daily fluid intake, some medicines and diseases are identified as causes in formation of stones.

Ureter stones:

Almost all stones in the ureter fall from the kidneys. They are mostly located at last 1/3 part of the ureter. The main symptom of these stones are pain and hematuria (bloody urine). Pain is connected with spasm caused by the movement of the stones inside the ureter. In addition, stones damage the ureter during movements and cause bloody urination. In some patients, stone totally blocks the ureter making impossible to urinate (anuria). There are three forms of anuria:

  • When patient is with a single kidney
  • When both ureters are blocked with stones
  • Reflectory spasm and blockage of the one ureter when the other one has been blocked.

What are the common stone types?

The most common type is calcium stones (oxalate and phosphate) and less common, infected stones, uric acid and cystine stones.

What kind of complaints cause ureter stones:

Ureter stones may cause pain, heartburn, nausea. In upper ureter stones, pain extends to the back and inguinal side. In lower ureter stones, pain may extend to the back, groin and testicles. In addition, there can be burning and frequent urination.

Risk factors of stone formation are as follows:

  • Urinary tract infections
  • Congenital abnormalities in the kidneys
  • Kidney diseases
  • Diet
  • Low liquid intake
  • Hot climate zone
  • Some drugs
  • Some intestinal diseases
  • Genetic factors
  • Previous intestine operations
  • Metabolic diseases

How is it diagnosed?

US examination, CT, pyelography (examining the kidneys by injecting special substance to vein), ureter and kidney examinations are used for the diagnosis.

How the ureter stones fall?

In general, if there is no narrowing and abnormality of the ureter, stones with size of 4-5 mm may fall themselves. In persons having previous stone falling it is even more easier.

resizedimage413373-ureteroscopeUnder what conditions intervention is required?

For making a decision on intervention, doctor shall check the kidney condition. If there is a serious infection and significant enlargement of the kidneys, in persons with single kidney and in case of other kidney functional disorders, intervention is required. In case of total ureter blockage, emergency intervention is required; otherwise, delay may cause irreversible changes in the kidney.

Does lack of pain mean stones have fallen?

Lack of pain is usually considered as improvement. However, this is a dangerous condition. Small stones cause more pain and complaints, as they are more mobile. Big stones cause less pain as they are less mobile. Lack of pain most times is deceptive to think than improvement started and it is very dangerous. One should not forget about the kidney damage in case of blocked urine flow.

What kind of problems may arise with stones?

The main complaint is pain. Infected stones in the ureter can be a source of infection for the whole body. Blockage in any part of the ureter may cause loosing kidney functions.

Treatment

80% of the kidney stones fall without any treatment. The main influencing factor is size of the stone. If 4-5 mm stones may fall themselves, for 8-9 mm stones, intervention is required. Stone form and located position in the ureter are also factors affecting the falling.

Daily minimum 2-liter fluid intake is a condition easing stone falling.

  • ESWL (stone breaking) and URS (closed) or open surgery options are used. Treatment option is selected depending on the size, location, condition of the ureters and kidneys.
  • General recommendations for patients with stones
  • Increase fluid intake (2 or more liters per day)
  • Decrease animal protein meals and salt consumption
  • If there is stone disease in the family, others also have the risk

In recurring stone diseases, it is recommended to have drug treatment for preventing the recurrence or delaying it. For this reason, test is necessary for identifying 24-hour urine, blood and stone’s chemical content.