Ureteric Calculi

URETERIC CALCULI

• Stone in the ureter usually comes from the kidney 

Ureteric colic

• Waves of agonizing loin pain referred to the groin, external genitalia and anterior surface of the thigh
• When the stone is in the intramural ureter, the pain is referred to the tip of the penis
• Strangury -painful passage of few drops of urine, when the stone is in the intramural part of the ureter

Impaction

• Five sites of anatomical narrowing where the stones may be arrested
  • Ureteropelvic junction
  • Crossing the iliac artery
  • Juxtaposition of vas deferens/broad ligament
  • Entering the bladder wall
  • Ureteric orifice
• When the stone gets impacted, attacks of colic give way to more consistent dull pain, often felt in the iliac fossa
• Distension of renal pelvis because of obstruction may cause pain and discomfort in the loin

Hematuria: Every attack of renal colic is associated with microscopic hematuria

Investigations

• X ray shows radio opaque stones in the line of ureter
  • Near the tip of the transverse processes of lumbar vertebrae
  • Sacroiliac joint
  • Medial to ischial spine
• IVU performed at the time of pain can confirm the diagnosis
• Spiral CT is being increasingly used

Endoscopic stone removal

• Dormia basket: now replaced by ureteroscopic techniques
• Ureteric Meatotomy: impacted stones in the intramural part of the ureter
• Ureteroscopic removal: impacted stones
• Push bang: stones in the middle or upper part can be flushed back into the kidney using a ureteric catheter. Subsequently treated with ESWL