How to expel stones stuck in the ureter?

Stones stuck in the ureter are a symptom of ureteral stones. Most of this type of stones originate from the kidneys. Many people do not know how to expel stones stuck in the ureter. For this problem, you can generally choose drug treatment and surgical treatment to expel the stones.

(1) General treatment:

Drink plenty of water, 2000ml/d. Those who cannot drink water or have vomiting should receive intravenous infusion. At the same time, take analgesics and antispasmodics or other treatments such as acupuncture and traditional Chinese medicine to help expel stones.

(2) Stone removal treatment:

Treatment is selected based on the size and location of the ureteral stones, the presence or absence of urinary tract infection, and the anatomical characteristics of the urinary tract. More than 90% of stones located in the lower ureter with a diameter of <0.4cm can be discharged on their own even without special treatment. More than 50% of stones with a size of 4.0-5.9mm can be discharged on their own, while only 20% of stones with a size of >6mm can be discharged. If the stones have not been expelled after more than 6 months of treatment, you should pay attention to check the kidney function and find out whether there is any infection in the urinary tract or any obstruction, so as to decide whether to continue observation or take active surgical treatment.

(3)ESWL:

With the continuous accumulation of ESWL clinical experience and the improvement of lithotripsy, the indications of ESWL for ureteral stones are constantly expanding. The absence of obstruction in the distal ureter and the lack of impact on stone excretion after lithotripsy are indications for ESWL treatment.

(4) Ureteroscopy:

Generally speaking, ureteroscopic lithotomy can be used for ureteral stones regardless of their location in any part of the ureter. However, it is currently believed that the best approach is to treat stones in the middle and lower segments, using ureteroscopy for ultrasonic lithotripsy, electrohydraulic lithotripsy, laser lithotripsy, pneumatic ballistic lithotripsy, and electronic kinetic lithotripsy. The first two methods have been basically abandoned due to their great damage to tissues.

(5) Surgical treatment

If the stones have been diagnosed for a long time and various non-surgical methods have been tried without success, surgery should be considered as soon as possible, especially if there is obvious water accumulation above the stones. Ureterotomy is feasible. The advantage of ureterolithotomy is that the operation is small and the stones can be removed completely, and even bilateral ureteral stones can be removed in one operation. Different surgical approaches are adopted according to the location of ureteral stones. During the operation, attention should be paid to fixing the stones to prevent them from slipping. The ureter is cut open at the upper edge of the stone. After the stone is removed, the ureteral catheter is used to explore its patency up and down, a double-J tube is placed, and then the ureter is sutured. Before surgery, a plain film of the urinary tract must be taken to determine the location of the stone and select the best surgical incision.

The indications for surgery are: ureteral perforation or ureteral stenosis during ureteroscopy; ureteral diverticulum complicated by stones; stone diameter >1.0cm or stone surface is rough and polygonal; stone impaction for too long, severe ureteral obstruction and upper urinary tract infection; non-surgical treatment is ineffective.