Ureteric Calculi: Causes, Symptoms, Treatment and Cost

Ureteric calculi, frequently referred to as kidney stones, are mineral and acid salt deposits that occur in the urinary system. These stones, which may vary in size from a few millimetres to several centimetres, can cause considerable discomfort while passing through the urinary system. Ureteric calculi may cause substantial pain and suffering based on their size and location.

The four main types of Ureteric Calculi are:

• Calcium Oxalate Stones: These stones are mainly composed of calcium oxalate, which is a naturally occurring substance found in many foods.
• Struvite Stones: These stones are usually caused by an infection in the urinary tract, such as a bladder infection, and contain magnesium ammonium phosphate crystals.
• Uric Acid Stones: These stones are composed of uric acid crystals and often form due to acidic urine or a diet high in purines (a type of protein found in many meats).
• Cystine Stones: These stones are rare but can occur due to an inherited metabolic disorder called cystinuria which causes excess levels of amino acids to build up in the urine.

The most common cause of Ureteric Calculi is a lack of fluid intake because it decreases the amount of urine produced, allowing minerals and salts to accumulate in the ureters. Other causes include:

• Dehydration
• Urinary tract infections
• Certain medications
• An obstruction in the urinary tract.

The most frequent ureteric calculi (kidney stones) symptoms are:

• Aching in the side and back, below the ribcage.
• Pain that originates in the lower abdomen and spreads to the groyne region.
• Nausea and vomiting.
• An abnormal presence of blood in the urine.
• Frequent, painful urination.
• Burning feeling while urinating.
• Urine that is cloudy or has a terrible odour.

Keeping a healthy lifestyle is the most effective defence against the development of ureteric calculi. This includes:

• Eating a balanced diet
• Avoiding cigarettes and excessive alcohol consumption.
• Engaging in some kind of physical activity.
• Taking care of any pre existing medical issues, such as diabetes or hypertension, and preventing any complications
• Additionally, certain medications such as diuretics can increase the risk of developing ureteric calculi and should be used with caution. Drinking plenty of fluids.
• Avoiding too much salt in the diet can also help reduce the risk.

Diagnosis of ureteric calculi is usually made through a combination of physical exam, imaging tests (such as ultrasound), and laboratory tests (such as urine analysis).

• Physical Exam: Your physician will do a thorough examination of your abdominal region in the course of a physical examination, looking for indications of pain or lumps.
• Imaging Tests: In order to confirm the diagnosis of ureteric calculi, imaging procedures such as an ultrasound or computed tomography (CT) scan are often performed. These tests may be able to help in determining the size of the stones as well as their placement inside the urinary system.
• Urine analysis: Urine analysis is used to determine if there is any presence of crystals in the urine which can be indicative of ureteric calculi.
• Blood test: A blood test may also be done to check for any signs of infection or other medical conditions that could be causing the formation of ureteric calculi.
• CT scan: The presence of ureteric calculi may be determined with the use of a CT scan of the abdomen and pelvis. This test uses X-rays to create a detailed image of the urinary tract, including any stones that may be present. The CT scan can also provide information on the size and location of the stones, which is helpful in determining the best treatment option.
• Ultrasound: Ultrasound is often used to confirm the diagnosis of ureteric calculi. Ultrasound is a non-invasive imaging technique that uses sound waves to create images of the body and is especially useful for detecting stones in the urinary tract due to its ability to detect small objects even in a fluid environment.

Ureteric calculi, or kidney stones, can cause a range of complications if left untreated. These can include:

• An infection that affects the urinary tract.
• Urinary tract obstruction
• Damage to the renal tissue due to obstruction of urine flow.
• Severe pain
• Nausea and vomiting.
• If larger stones pass through the ureter they may cause obstruction of blood vessels in the area or even laceration of the ureter itself.
• If a stone becomes lodged in the bladder it can cause pressure on surrounding organs and can lead to further complications such as bladder stones or acute renal colic.
• Finally, untreated kidney stones can result in chronic kidney disease if left unchecked for an extended period of time.

• Consuming a large amount of water during the day might help in the removal of any stones that may be present in the urinary system.
• Consume herbs like Punarnava, Gokshura, Varun, and Shilajit to reduce inflammation and help dissolve any stones in the ureter.
• Try taking supplements of magnesium or calcium citrate as they can help break down small stones in the ureters and also prevent new ones from forming.
• Ayurvedic oils such as Mahanarayan oil or Ksheerabala oil can be applied externally on the lower abdomen to reduce pain caused by Ureteral Calculi.
• Do yoga poses like cobra pose (bhujangasana) or windshield wiper pose (pavanamuktasana) for a few minutes every day to soothe pain caused by Ureteral Calculi .

• In general, it is recommended to follow a low-oxalate diet when suffering from ureteric calculi.
• Eating more fruits and vegetables that are low in oxalates such as broccoli, cauliflower, cabbage, cucumbers and apples can help reduce the risk of forming kidney stones.
• Additionally drinking plenty of fluids (at least 2 litres a day) may help flush out stones that are present in the ureter.

• It is important to avoid high-oxalate foods such as spinach, beets, rhubarb, sweet potatoes, nuts, chocolate, tea, and wheat bran when dealing with ureteric calculi.
• Foods high in calcium and magnesium are also best avoided. These include dairy products such as milk and cheese, certain grains such as wheat, rye and barley and some fruits such as oranges and bananas.
• Processed foods should also be avoided.

Your doctor may prescribe one or more of the following treatments for you, depending on the size of the stone and where it is located in your body:

• Medication: Your physician may prescribe medicine to help in disintegrating and passing the stone. These medications may include alpha-blockers, which relax the muscles in your ureter to help move the stone along, or they may also include calcium channel blockers that reduce pain caused by spasms in your ureter.
• Shock wave lithotripsy (SWL): SWL uses high shock waves to shatter kidney stones into smaller fragments that may move through the urinary system more readily.
• Ureteroscopy: This procedure involves inserting a thin tube with a camera attached at one end into your urethra, bladder, and ureters in order to locate and remove stones from within them.
• Percutaneous nephrolithotomy (PCNL): PCNL is a minimally invasive procedure that involves making an incision in your back through which instruments are inserted to remove larger stones from within your kidney or upper urinary tract.
• Extracorporeal shock wave lithotripsy (ESWL): ESWL is similar to SQL but uses external shock waves instead of internal ones to break up large stones into smaller pieces that can pass through more easily

It is best to consult with a urologist, who specialises in treatment of disorders related to urinary tract and reproductive organs.

Commonly used medications include:

• Alpha-blockers: These medications help relax the muscles of the ureter and reduce pain during urination. For example: Tamsulosin (Flomax), Alfuzosin (Uroxatral), Silodosin (Rapaflo).
• Pain medications: Ibuprofen and other nonsteroidal anti-inflammatory medicines (NSAIDs) may help alleviate the discomfort produced by ureteral calculi.
• Antibiotics: These are sometimes prescribed to treat infections associated with ureteric calculi, such as a urinary tract infection (UTI).

Recovery from Ureteric Calculi generally takes between 2 to 6 weeks, depending on the severity of the condition and the treatment received. Following a healthy diet and lifestyle can help aid in the healing process.

The results of ureteric calculi treatment depend on the severity of the condition and the type of treatment used.

After successful treatment, most patients experience full symptom relief with no recurrence of stones.However, there is a chance that new stones may form in the future due to underlying conditions such as urinary tract infections or metabolic disorders.

Therefore, it is important for patients to continue following their doctor's instructions regarding diet and lifestyle changes to reduce their risk of recurrence.

Post-surgical treatments for ureteric calculi typically involve a combination of antibiotics, pain management, and other supportive measures. In some cases, additional surgery might be needed to remove any remaining stones or to repair damage from the initial procedure.

• Pain Management: Analgesics may be prescribed to help with discomfort or pain associated with the procedure.
• Hydration: It is important to stay hydrated after your procedure in order to help flush out any residual stones as well as help with healing and recovery time.
• Follow-up Appointments: Regular follow up appointments are recommended in order to ensure that any remaining stones have been successfully removed and that no complications have arisen following the surgery.
• Dietary Changes: Diet modifications such as increasing fibre intake, reducing salt consumption, avoiding certain types of food (e.g., red meat), and drinking more water can help reduce stone recurrence in some patients following surgery for ureteric calculi.

The cost of treatment for Ureteric Calculi in India varies depending on the type of treatment, the severity of the condition, and the hospital or clinic where treatment is sought.

Generally, the cost can range from as low as Rs. 5000 to as high as Rs. 1 lakh or more for complex procedures such as ureteroscopy or lithotripsy. The cost also includes medicines, laboratory tests and other associated costs like accommodation and food.

The following are the most frequent side effects of ureteral calculi treatment:

• Pain, especially when passing urine.
• Nausea and vomiting
• Blood in the urine.
• Frequency and urgency of urination.
• Unusually coloured or foul smelling urine.
• Kidney infection.

If you are suffering from any complications relating to Ureteric Calculi then you should consult a doctor nearby as they can cause complications like infection in the urinary tract, blockage of the urinary tract or damage to the renal tissue, etc. in which treatment course can range from a few months to years depending on the severity of the situation.