The ureter is a muscular passage that connects the kidneys to the bladder, through which urine passes to the bladder, which gets rid of it outside the body. Ureteral stones, symptoms, diagnosis, and treatment.
Symptoms of ureteral stones:
The nature, size and location of the stone are among the main factors that affect the symptoms that the patient feels, but in all cases, the patient often suffers from renal colic, along with some
other symptoms such as:
blood with urine;
Burning sensation in urine.
Sudden interruption of urination.
Desire to vomit.
The relationship between the location of ureteral stones and the symptoms
if the stone is in the upper third of the ureter, it causes pain in the middle of the abdomen that extends to the lower back.
if the stone is in the middle third of the ureter, the pain is in the middle of the abdomen only. But if the stone is in the lower third of the ureter, the patient feels pain in the middle of the abdomen that extends to the upper thigh and it may radiate to the Testis in men.
History taking of the patient condition including local abdominal examination.
Radiological examination including:
* CT scan
Methods of treating ureteral stones:
1- Medical treatment: It is used with small stones that do not exceed several millimetres in diameter and that do not obstruct the passage of urine from the ureter, as some medications help in their disappearance and descent with urine.
2- Shock wave lithotripsy ( SWL ): it is the disintegration of stones using External shock waves to small fragments which are passed spontaneously with urine to outside the body
3- Endoscopic stone Retrieval: This method is used with for stone extraction after stone Disintegration using LASER lithotripsy
4- Surgery: it is a surgical operation with anaesthesia to extract stones, which are often used for stones which are large in size and in cases which the doctor cannot insert the endoscope, and they did not respond to other methods of fragmentation.
Endoscopic Ureteral stone retrieval:
Endoscopic management of ureteral stones is a procedure that begins with inserting the endoscope into the urethra, until it reaches the ureteral stone. The endoscope camera gives an accurate picture of the ureter and the stone, its location and size, and then the doctor targets it with LASER lithotripsy , fragmentingit and turning it into small particles, then the Doctor pulls the fragments out Using special Forceps , This procedure usually Requires anaesthesia which may be spina or general aesthesia depending on the patient’s medical condition and it usually takes around 1 to 2 hours
The type of endoscope used for endoscopic management of ureteral stones
The rigid endoscope is used to break up ureteral stones if the stone is in the lower region of the ureter, while the flexible endoscope is used in most endoscopic ureteral stone fragmentation operations.
SWL is usually used for stones less than 1.5 centimetre.
The patient does not suffer from any Urinary Tract infections
The patient does not suffer from kidney obstruction.
if the patient’s condition does not improve and the stones are not broken down during one or two sessions at most of the shockwave , these sessions should not be repeated and attempts to treat in this way should be stopped, and the doctor usually shift to endoscopic fragmentation of ureteral stones as an alternative and final solution.
it is a mineral mass that forms in the bladder due to the patient’s inability to get rid of urine completely when the concentrated minerals and foreign substances crystallize in the urine, to become a stone, the stones may be small and descend with the urine without treatment, but in some cases the patient must undergo Medical treatment Or surgery, and if bladder stones are neglected without treatment, the patient may be exposed to
infection or complications, and the largest percentage of bladder stones patients are men over the age of fifty.
Usually, even large bladder stones do not result in any symptoms or problems, but if the stones lead to irritation in the bladder wall or prevent the descent of urine and the patient is exposed to episodes of urinary retention, it may result in the following
Pain in the lower abdomen
Painful urine with frequent urination
Difficulty and interruption in urination Presence of blood in
Urine becomes cloudy and discoloured
Causes of bladder stones:
Enlarged prostate gland: it may cause the formation of bladder stones in men because the enlargement of the gland obstructs the flow of urine, and prevents the bladder from getting rid of urine, allowing sediment and salt to accumulate and the formation of stones.
Nerve damage: in case of damage to the nerves that give signals to the bladder and direct it to contract or relax; The bladder may lose the ability to completely expel urine. Bladder infections: Urinary tract infections or
exposure of the abdomen to radiation therapy are among the things that may lead to the formation of bladder stones. Medical devices: the use of a bladder catheter in cases of urine retention in the bladder and its inability to expel it; It may cause the formation of bladder stones, and some crystals formed on the equipment used in gynaecology or the urinary stent can move to the bladder, which may later turn into stones.
Kidney stones: Some of the small kidney stones that reach the bladder, do not go out with the urine and with time, the impurities suspended in the urine are deposited on them that turn into bladder stones. Any problem that obstructs the flow of urine and its descent from the bladder may lead to the formation of bladder stones, and the most common cause is an enlarged prostate.
The traditional examination: the regular and manual examination of the doctor to confirm the enlargement of the prostate.
Urine sample analysis: Conducting a microscopic analysis of a urine sample to detect the presence of blood, bacteria or crystallized minerals that may be the cause of bladder stones.
CT scan, ultrasound, and x-rays are used to detect the presence of bladder stones.
At first, the doctor prescribes some drug treatments in addition to advising the patient to drink at least 3 litters of water and fluids that help the bladder get rid of small stones by passing out with urine, but as a result of bladder stones often formed because the ladder is not completely rid of urine, it may not be considered Water and fluids are a solution to get rid of these stones, so the treatment is to remove the stones and get rid of them is the solution.
Bladder stones removal methods:
1- Endoscopic removal of bladder stones:
The doctor inserts the endoscope through the urethra under local anaesthesia into the bladder to allow the doctor to see the stone. Then, he directs a laser or ultrasound to the stone until it is broken up and drained outside the bladder. The process of breaking up bladder stones with endoscopy is faster, easier and more accurate, and complications are rare for the patient during it.
2- Surgical removal:
Surgical removal of bladder stones is used for large size stones or because there are difficulties in breaking them up, so the solution is to remove these stones through traditional surgery.
kidney stones :
Kidney stones are formed as a result of a genetic factor or as a result of a lack of fluid in the blood and high levels of salt and some minerals in the urine for a long time.
Symptoms do not appear in a most of cases as long as the stone is stationary and does not move in the kidneys, but it may cause sharp and sudden pain when it moves outside the kidneys. Besides the pain, the patient may feel a rise in his body temperature ( Fever ) with a desire to vomit,
with a change in the color of urine to red
In cases of small stones, the doctor prescribes to the patient some treatments that help the body get rid of the stone, anti- inflammatory and analgesics. In cases of large stones that are difficult to get out of the body, or when they are stuck inside the kidney tissues, in this case, the solution is to break up the kidney stones with laser.
Laser disintegration of kidney stones
It is done through special scope that goes into the kidney either through the Flank using a rigid scope or using Flexible scope that can go into the kidney through the urethra
During this procedure, the doctor is guided by
X-Rays ; To determine the location of the stone , and after inserting the endoscope through the urethra to the bladder then to the affected through its ureter , then stone is identified with the flexible scope , by using the laser fiber the stone is disintegrated into small fragments that can be either extracted using special basket or easily go out with urine
The patient can return to his home on the same day or the next day, according to his health condition . The patient often feels discomfort and fatigue after the removal of kidney stones by laser, along with a burning sensation during urination for a few hours after the operation and these symptoms do not last long but go away gradually.
2.PCNL ( percutaneous Nephrolithotripsy ): lt is an Endosxopic procedure during which a large kidney stone can be extracted through a small Percutaneous (Skin ) incisi0n in the patient flank after stone Disintegration Using special forceps
Kidney stone removal surgery cost
The cost of Endoscopic lithotripsy depends on the type of endoscope used, flexible or Rigid
Other factors include stone location, size and composition.
Procedures and care that is provided to the patient before, during and after the operation. The doctor’s experience and medical status, services and level of equipment of the medical center in which the operation is performed
What are the necessary tips to avoid urinary stones?
Drinking fluids constantly, especially water, in an amount of not less than 3 liters per day, helps prevent the deposition of salts and the formation of stones. Visit your doctor before taking any drugs, specially vitamins and nutritional supplements. Nutritional balance and healthy diet.
Kidney, ureter and bladder stones are among the most pathological conditions facing the urinary system and result in serious complications if the patient neglects them and does not care quickly to go to the
appropriate doctor to treat them. Dr. Mohammed Metwally uses the latest treatment techniques with expertise and high efficiency, and the cure rates among his patients are the biggest evidence