The ten to twelve inches long tube carrying urine from the kidney to the urinary bladder is known as the Ureter. There are two ureters, one attached to each kidney in human beings. Urine flows down partly by gravity, but mainly by waves of contractions, which pass several times per minute through the muscle layers of the urethral walls. Each ureter enters the bladder through a tunnel in the bladder wall, which is angled to prevent the urine from running back into the ureter when the bladder contracts.
There are salts and minerals in the urine that stick together to form small “pebbles.” They are usually painless while they remain in the kidney. But they can cause severe pain when small pieces leave the kidney and travel through the narrow tubes (ureters) to the bladder. Once it is free in the renal pelvis and passes through the ureter it can stick anywhere, but it is most likely to stick: (1) at the pelviureteric junction, (2) in the upper or (3) in the lower third of the ureter, or (4) at the entry of the ureter into the bladder.
As the stone passes down the ureter, it causes severe ureteric colic, even a tiny one causes agony. It causes severe pain in the loin, radiating to the groin, perineum, and testis or to a woman’s labia.
Different types of tests are done to find out whether a person is suffering from ureteric stones
1) Ultrasonography
2) X-rays
3) Excretory urography
4) Urinalysis
5) Special imaging of your urinary tract (intravenous pyelogram).
a) One of the most common ways to remove stone is Shock-Wave lithotripsy (SWL).
b) This procedure involves breaking of stones with the help of a machine from outside the body. Focused shock waves (short pulses of high energy sound waves) are transmitted to the stone through the skin which helps to break them into smaller pieces. The stone fragments then pass with urine.
The advantages of his procedure are low risk of complications and there is no need for anesthesia.
c) The second way to remove the stones is Ureteroscopy (URS), a type of treatment done with a small-caliber endoscope. URS is common, success rates are very high, and the risk of complications is low. For URS the patient will be given general or local anesthesia. Once he is under anesthesia, the doctor enters the bladder with the endoscope through the urethra without making an incision in the body. The stone is pulled out using a special “basket”.
The advantages of URS are immediate stone removal and low risk of complications.
d) Another way that removes stones directly from the skin is Percutaneous Nephrolithotomy (PNL). This involves removing medium-sized or larger renal calculi (kidney stones) from the patient’s urinary tract by means of a nephroscope passed into the kidney through a track created in the patient’s back. The term “percutaneous” means that the procedure is done through the skin. Nephrolithotomy is a term formed from two Greek words that mean “kidney” and “removing stones by cutting.”
During a percutaneous nephrolithotomy, the surgeon inserts a needle through the patient’s back directly into the kidney (B). A nephroscope uses an ultrasonic or laser probe to break up large kidney stones (C). Pieces of the stones are suctioned out with the scope, and a nephrostomy tube drains the kidney of urine.
The advantage of this procedure is even very big stones can be removed completely during one single operation.
