Sexually Transmitted Diseases - I. I. Mavrov 2005

Diseases of the reproductive organs of various etiologies
Ureteral calculi

Ureteral calculi are almost invariably secondary, originating as Kidney stones that have migrated into the Ureter and become lodged there. Primary ureteral stones are extremely rare; their formation is typically associated with ureteral atonia, stricture, or diverticulum.

In most cases, these stones are solitary, round or oblong, small in size, with a smooth or spiculated surface. Only on rare occasions do ureteral stones grow large enough to completely occlude the lumen. They are usually unilateral, rarely bilateral, and occur more frequently in men. Patients with ureteral stones account for 28–30% of all cases of urolithiasis.

Stones most commonly lodge at the physiological constrictions of the ureter: at the pelvoureteric junction; where the ureter crosses the iliac vessels; and in the juxtavesical and intramural segments. Prolonged retention of a stone in the ureteral lumen disrupts urine outflow, leading to dilation of the ureter and renal pelvis (hydroureter and Hydronephrosis). At the site of impaction, the ureteral wall undergoes sclerosis, resulting in a stricture. Secondary infection can cause urethritis, periurethritis, and purulent-inflammatory renal disease.

Clinical presentation. The hallmark symptom of a ureteral stone is Renal Colic. During the intervals between attacks, patients experience dull pain in the renal region and along the course of the ureter, radiating to the groin and genitalia. Stones located in the juxtavesical segment are accompanied by dysuria. When a stone descends into the lower third of the ureter, urinary frequency increases. Occasionally, intestinal paresis may occur, even simulating bowel obstruction with signs of Peritonitis. Pasternatsky's sign is positive. Trauma to the ureteral mucosa leads to microhematuria, and less frequently, macrohematuria. Pyuria is observed in 50% of patients with ureteral calculi (in the presence of Urinary Tract infections).

Diagnosis is established based on the clinical presentation, chromocystoscopy, radiography, and ultrasound. Tomography is frequently useful for diagnosing ureteral stones whose shadows are obscured by bone structures on plain abdominal radiographs. In women, stones located in the intramural and juxtavesical segments of the ureter can sometimes be detected via vaginal Palpation.

Treatment may be either conservative or surgical. Spontaneous passage of the stone following recurrent ureteral colic occurs in 75–80% of patients. Sometimes, stone expulsion can be achieved by relieving the renal colic (using warm baths, antispasmodics, etc.). Conservative management is effective when the stone has a smooth surface and a diameter of up to 1 cm. In such cases, a forced fluid regimen (ingesting 1–1.5 L of fluid over 10–15 minutes) combined with antispasmodics and vigorous walking is indicated. For stones located in the juxtavesical part of the ureter, ureteral catheterization with the instillation of warm liquid petrolatum (mineral oil) or glycerin, or The Use of other specialized stone-extraction devices, may be employed. Indications for surgical intervention include the failure of conservative therapy, The Development of ureteral atonia, fever caused by upper urinary tract infections, and frequent recurrent attacks of renal colic.