Ureteric calculi

Summary: Referral indicated for all ureteric calculi >5mm diameter and, as an emergency, for uncontrolled symptoms

Advice: Referral indicated for all ureteric calculi >5mm diameter and, as an emergency, for uncontrolled symptoms.
Refer To: Generic referral (to any urologist)

Contents:

Natural history

Overall, 60% of patients with a ureteric calculus will pass the stone spontaneously within 4 weeks and without the need for urological intervention. This figure rises to 90% for calculi less than 5mm diameter.

90% of patients with ureteric calculi will have blood in their urine (visible or microscopic).

70% of ureteric calculi are already in the lower third of the ureter by the time of presentation.

The investigation of choice for suspected renal colic is now unenhanced spiral CT. IVU may still be used in some centres but ultrasound alone has no role in the assessment of suspected renal colic.

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Indications for urological intervention

Referrals for renal colic should be made generically using a normal referral letter (or through Choose & Book).

Intervention may only involve percutaneous insertion of a nephrostomy tube (under LA), which can decompress the kidney and may subsequently allow the stone to pass spontaneously once effective peristalsis is reestablished. Definitive stone removal may not, therefore, be necessary in all patients.

Click here to download a spreadsheet which aids the management of patients with renal colic.

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Treatment options

  • Transurethral ureteroscopy (for calculi in the lower and middle thirds of the ureter)
  • Lithotripsy in situ (for calculi in the upper third of the ureter)
  • Push-bang treatment (endoscopic dislodgment of the calculus into the kidney with insertion of an ureteric stent and subsequent lithotripsy)
  • Push-pull treatment (endoscopic dislodgment of the calculus into the kidney with one-stage percutaneous removal)
  • Open ureterolithotomy (rarely employed)
  • Laparoscopic ureterolithotomy (not currently available)

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Related Downloads

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