The key decision in patients who present with stones in the ureter is whether to operate or to treat expectantly with analgesia and Medical Expulsion Therapy.
Surgery is required for a stone in the ureter when:
- The stone in the ureter is associated with a fever. This is a surgical emergency as a blocked kidney in association with a urinary infection is a life-threatening emergency which requires urgent therapy to unblock the kidney.
- The stone in the ureter is in a patient who only has one functioning kidney.
- The stone in the ureter is causing the overall kidney functioning to be compromised significantly. This can be ascertained by a blood test.
- The stone in the ureter is causing ongoing severe pain which is intolerable or too persistent.
- The patient has had enough of pain and waiting for the stone to pass.
- The stone is larger than 5-6mm and is unlikely to pass spontaneously. It should be noted that some patients can pass stones larger than this (with pain).