Treatments for Ureteric Stones

Kidney stones become ureteric when they move into the ureter, the pathway between bladder and kidney. In fact, most urinary stones don't actually cause much misery until they reach the ureter. Ninety percent to 95 percent of these stones will merrily make their own way through the urinary system. Then, there are those that don't. Thankfully, there are solid options for treatment of ureteric stones.

Medication

• In many instances, urologists will choose to treat the stone with medication, primarily to encourage it's continued forward motion. Alpha blockers help smaller stones pass through the system. These medicines help to relax muscles inside the ureter and encourage it to allow the stone to move through. Alpha blockers include doxazosin (brand name Cardura), terazosin (brand name Hytrin), tamsulosin (brand name Flomax) and alfuzosin (brand name Uroxatral).

Time Frame

• Passage of a kidney stone can often take from four to six weeks. Physicians will likely conduct several imaging sessions to ensure the stone's continued movement. Should a determination be made that the stone is too large to pass naturally, or if it turns into an obstruction, failing to continue forward, then one of several procedures may be called for.

ESWL

• ESWL is the preferred treament for ureteric stones primarily because it is the least-invasive. The full name for this procedure is "extracorporeal shock wave lithotripsy." Lithotripsy is a Greek word that means "stone crushing." A machine sends shock waves to the kidney stone with the intention of breaking it apart into smaller segments that will be easier to pass through the urine.

  Older models of this machine have patients sitting in a tub of water, while newer versions allow the patient to simply lie on a table. Physicians at Cornell University's Department of Urology note that ESWL shows the most reliability when focused on softer stones. Large or multiple stones may require additional ESWL treatments.

Ureteroscopy

• Also known as laser lithotripsy, doctors insert an object called an ureteroscope into the patient's urethra. This is a long, wire-like device that moves through the bladder to the ureter where the stone is waiting. The urologist views the stone through a small camera inside the ureteroscope. The irritant is then either destroyed by a laser fiber or removed by a small basket inside the instrument. This method requires one to three hours of procedure time with no hospital stay.

PCNL

• Percutaneous nephrostolithotomy (PCNL) is the most invasive of the three primary surgical procedures. It's the only technique in common practice that requires any actual cutting. A physician applies a small incision to the patient's back and tunnels through the skin with a miniature telescope (called a nephroscope) to the stone lurking in the kidney. The stone is then broken apart with a tiny laser beam. This procedure is primarily reserved for large or hard stones.

Warning

• In his paper "Update on the Management of Ureteric Stones" written for the Hong Kong Medical Diary, Dr. Frances Lee notes some concern regarding the effect on fertility of those who undergo ESWL treatment. "Possibility of damage to unfertilized eggs and ovaries has been raised," he says. " While for men there is a significant deterioration in semen quality."

  This condition has been noted in males for up to 12 weeks after ESWL treatment.