Clinically Reviewed By
Mr Alberto Coscione
Consultant Urological Surgeon · Reviewed July 2026 · Review due July 2027
What Are Ureteric Stones?
A ureteric stone is a kidney stone that has passed from the kidney into the ureter — the narrow muscular tube that connects the kidney to the bladder. Once a stone enters the ureter it can cause sudden, severe pain known as renal colic, and it is the single most common reason for emergency urology admission in the UK.
The ureter has three natural narrowing points where stones are most likely to become impacted:
Pelvi-Ureteric Junction (PUJ)
Where the kidney urine collection system narrows to become the ureter.
Pelvic Brim
Where the ureter crosses the iliac blood vessels at the top of the hip bones.
Vesico-Ureteric Junction (VUJ)
The narrowest point, where the ureter enters the bladder wall.
Understanding the stone's location and size is critical because it determines both the likelihood of the stone passing without need for treatment and the most appropriate treatment strategy.
Recognising Ureteric Stone Symptoms
Ureteric colic is one of the most painful conditions a person can experience.
Acute Loin-to-Groin Pain
Sudden severe flank pain shooting down to the groin, inner thigh, or genitalia. Patients are typically unable to find a comfortable position.
Colicky Nature
The pain comes in waves as the ureter spasms around the stone, with intervals of partial relief between episodes.
Haematuria
Blood in the urine (visible or only detectable with dipstick tests) is present in the majority of cases due to irritation as the stone moves through the ureter.
Nausea & Vomiting
The severe pain commonly causes nausea, vomiting and occasionally sweating.
Urinary Urgency & Frequency
As the stone approaches or reaches the join near the bladder, patients often experience a strong urge to pee and increased frequency — symptoms that can feel like a urinary tract infection.
Important differential diagnoses: Several other acute abdominal conditions can appear like a ureteric colic. This is why prompt tests and specialist assessment are essential to confirm the diagnosis.
How We Diagnose Ureteric Stones
Accurate diagnosis requires a combination of scans and blood tests to confirm the stone, assess its size and location, and check for complications such as infection or kidney impairment.
Urgent CT KUB (Non-Contrast CT)
The gold standard investigation. A low-dose, non-contrast CT scan of the kidneys, ureters and bladder can detect over 99% of stones. It shows the exact size, location, density and any secondary signs of obstruction such as swelling of the kidneys or inflammation of the tissues around the kidney.
Ultrasound
Useful as a first-line test in pregnancy or when CT is not immediately available. Ultrasound can reliably detect hydronephrosis (swelling of the kidney) caused by obstruction, though it cannot always visualise the stone itself within the ureter.
Blood Tests
Essential blood tests include tests looking at infection and kidney function. Elevated inflammatory markers with an obstructing stone may indicate an infected, obstructed kidney, which is a urological emergency.
Urine Dipstick
A bedside urine dipstick test checks for blood (supporting the diagnosis), white blood cells, and nitrites (suggesting infection). A mid-stream urine sample is sent for culture if infection is suspected.
Treatment by Location & Size
The optimal treatment approach depends on the stone's size, position in the ureter, the degree of obstruction, whether there are signs of infection and patient choice. Here is how we approach stones at each level:
Proximal (Upper) Ureter
Stones in the upper ureter near the kidney. Treatment options include:
- ›Extracorporeal Shock Wave Lithotripsy (ESWL): Non-invasive option for stones under 10mm. Shock waves fragment the stone from outside the body.
- ›Flexible Ureteroscopy (FURS): Preferred for larger or harder stones. A flexible scope is passed up to the stone and laser energy is used to fragment it.
Mid Ureter
Stones at the level of the pelvic brim where the ureter crosses the iliac vessels.
- ›Ureteroscopy (URS): The preferred approach. ESWL is less effective at this level due to overlying bone, so direct endoscopic treatment with laser lithotripsy is usually recommended.
Distal (Lower) Ureter
Stones near or at the vesico-ureteric junction. These have the highest spontaneous passage rate.
- ›Stones under 5mm: Very high chance of passing spontaneously (up to 80–90%). Watchful waiting with pain management is often appropriate.
- ›Stones 5–10mm: Medications may be considered as part of Medical Expulsive Therapy (MET). These include alpha-blockers (e.g. tamsulosin), which may be offered to relax the distal ureter and improve the chance of spontaneous passage. NICE (the National Institute for Health and Care Excellence) recommends a trial of up to 4 weeks before considering intervention.
- ›Stones over 10mm or failed MET: Ureteroscopy is recommended when the stone is unlikely to pass spontaneously, fails to pass within the observation period, or the patient has intractable symptoms.
Emergency Stenting & Nephrostomy
An infected, obstructed kidney is a urological emergency. If a patient presents with fever and pain, and feels very unwell, the kidney must be unblocked — either by inserting a ureteric stent (JJ stent) or a percutaneous nephrostomy tube. Definitive stone treatment is deferred until the infection has been treated with antibiotics.
In a small number of patients, ureteric strictures can develop after treatment for stone disease — these can usually be managed with balloon dilatation or laser endoureterotomy but occasionally require ureteric reconstruction.
Ureteroscopy & Laser Lithotripsy
Ureteroscopy (URS) is the most commonly performed procedure for ureteric stones. It is a minimally invasive, telescope-based technique that allows direct visualisation and treatment of the stone without any skin incisions.
Semi-Rigid Ureteroscopy
A slim, rigid telescope is passed through the urethra (the water pipe draining the bladder) and bladder into the ureter. Ideal for mid and distal ureteric stones. The stone is fragmented using a laser and the fragments are removed or allowed to drain.
Flexible Ureteroscopy
A flexible scope with a deflectable tip is used for proximal ureteric and renal stones. Combined with laser lithotripsy, this allows access to difficult-to-reach stones including those that have migrated back into the kidney.
What to Expect
General Anaesthetic: The procedure is usually performed under general anaesthesia as a day case. Most patients go home the same day.
Laser Fragmentation: A laser is used to break the stone into tiny fragments or dust, which are then either extracted or allowed to pass naturally.
Stent Placement: A temporary ureteric stent (JJ stent) is often placed after the procedure to keep the ureter open and allow any swelling to settle. The stent is typically removed 1–2 weeks later in a brief outpatient procedure.
Recovery: Most patients can return to normal activities within 2–5 days. Some discomfort, episodes of blood in the urine and urinary frequency are normal in the first few days, particularly if a stent has been placed. Heavy lifting and strenuous exercise should be avoided for 1–2 weeks.
When to Seek Emergency Help
While many ureteric stones can be managed with a watch-and-wait approach, certain situations require emergency medical attention. Seek urgent help if you experience any of the following:
Fever with a Known Stone
A temperature above 38°C alongside ureteric colic may indicate an infected, obstructed kidney (pyonephrosis) — a life-threatening emergency requiring urgent decompression.
Single Functioning Kidney
If you have only one working kidney (solitary kidney), any obstruction can lead to rapid loss of kidney function and requires urgent assessment.
Bilateral Obstruction
Stones blocking both ureters simultaneously can cause acute kidney injury. This is rare but requires emergency decompression of at least one side.
Uncontrollable Pain
If pain cannot be controlled with tablets, hospital admission for intravenous pain relief and further assessment is necessary.
Rising Creatinine
Worsening kidney function tests (elevated serum creatinine) indicate that the obstruction is impairing kidney drainage and urgent intervention may be needed to prevent permanent kidney damage.
Meet your Specialist
At London Urology Specialists, the assessment and treatment of ureteric stones is led by Mr Alberto Coscione, a consultant urological surgeon with specialist expertise in endourology and the minimally invasive management of urinary tract stones.
Key Takeaways
Fever with a stone, single kidney, bilateral obstruction, or uncontrolled pain are emergencies requiring immediate attention.
- Ureteric stones are the most common cause of emergency urology admission, causing sudden severe loin-to-groin pain.
- CT KUB is the gold standard for diagnosis — fast, accurate, and widely available.
- Small stones (<5mm) often pass spontaneously; larger stones typically require ureteroscopy with laser lithotripsy.
- Ureteroscopy is a minimally invasive day-case procedure with excellent stone-free rates and rapid recovery.
Further Reading — BAUS Patient Information
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