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Mid Ureteric Stone Treatment

Mid Ureteric Stone Treatment

📖 9 min read Written/reviewed by Dr. Alhad Naragude, MBBS, MS, DrNB Urology Last updated: June 14, 2026

A mid ureteric stone is a kidney stone stuck in the middle part of the ureter, the tube that carries urine from the kidney to the bladder. Mid ureteric stone treatment depends on stone size, pain, fever, urine infection, kidney swelling and kidney function. Small stones may pass with medicines and observation. Stones that are larger, stuck, repeatedly painful, infected or causing significant kidney swelling may need URSL with laser, ESWL shock wave treatment or temporary drainage with a DJ stent. Fever with a blocked stone is an emergency.

What is a mid ureteric stone?

The ureter is a narrow tube between the kidney and bladder. A stone can get stuck in the upper, middle or lower part of this tube.

A mid ureteric stone means the stone is stuck in the middle portion of the ureter. On reports, you may see words like:

  • Mid ureteric calculus.
  • Calculus in mid ureter.
  • Mid ureter stone with hydroureteronephrosis.
  • Obstructive uropathy due to ureteric calculus.

Hydroureteronephrosis means swelling of the ureter and kidney because urine is not draining freely.

A mid ureter stone can cause severe pain because the ureter tries to push the stone down while urine flow is blocked.

Common symptoms of a mid ureteric stone

Symptoms may include:

  • Severe side pain or back pain.
  • Pain moving towards the lower abdomen or groin.
  • Nausea or vomiting.
  • Burning urine.
  • Blood in urine.
  • Frequent urge to pass urine.
  • Restlessness during pain.
  • Fever or chills if infection develops.

Some patients have mild pain but significant kidney swelling. That is why treatment should not be decided only by pain severity.

Mid ureteric stone treatment: what decides the best option?

The best treatment is not chosen by stone size alone. A urologist usually considers:

  • Stone size in mm.
  • Exact level of the stone.
  • Whether the stone is moving down or stuck.
  • Kidney swelling on ultrasound or CT.
  • Pain severity and recurrence.
  • Fever or urine infection.
  • Creatinine and kidney function.
  • Whether the patient has one functioning kidney.
  • Stone hardness on CT.
  • Patient’s work, travel and follow-up reliability.

The AUA surgical guideline summary notes that treatment choice depends on patient factors, urinary tract anatomy and stone characteristics, with shared decision-making based on patient goals, available resources and surgeon expertise.

Can a mid ureteric stone pass naturally?

Yes, some mid ureteric stones can pass naturally, especially when they are small and there is no infection or kidney function problem.

EAU guidelines report spontaneous passage rates of 58% to 70% for mid-ureteral stones, but also note that passage decreases as stone size increases. In the data cited by EAU, about 75% of stones under 5 mm and 62% of stones 5 mm or larger passed spontaneously, with average passage around 17 days.

This does not mean every 5-6 mm stone should be observed. A small stone with fever, severe swelling or rising creatinine may still need urgent treatment.

Simple treatment guide by stone size

Stone size Usual treatment direction Practical meaning
Less than 5 mm Observation may be possible Often passes if pain is controlled and there is no infection.
5-7 mm Trial of passage or procedure Depends on pain, swelling and whether the stone is progressing.
7-10 mm Active treatment often discussed URSL or ESWL may be needed if pain recurs or stone is stuck.
10-20 mm Usually needs active treatment URSL is commonly preferred for reliable clearance.
More than 20 mm Specialist planning Treatment depends on impaction, anatomy and associated kidney stones.

NICE recommends SWL for ureteric stones under 10 mm in adults, with URS considered when SWL is unsuitable, not targetable, fails or cannot clear the stone within 4 weeks. For ureteric stones 10-20 mm, NICE recommends URS as the primary option.

When can you safely wait?

Observation may be reasonable when:

  • The stone is small.
  • Pain is controlled with medicines.
  • There is no fever.
  • Urine infection is absent.
  • Creatinine is normal.
  • Kidney swelling is mild.
  • The patient can return quickly if symptoms worsen.

EAU guidelines support observation for newly diagnosed small ureteral stones only when active removal is not indicated and the patient is followed periodically. Observation should stop if infection, refractory pain or worsening kidney function develops.

When should you not wait?

You should not keep waiting at home if you have:

  • Fever or chills.
  • Severe pain despite medicines.
  • Repeated vomiting.
  • Reduced urine output.
  • Rising creatinine.
  • Significant kidney swelling.
  • A single functioning kidney.
  • Pregnancy with stone pain.
  • Diabetes or poor immunity with fever.
  • Stone pain with weakness, confusion or low blood pressure.

EAU lists low likelihood of spontaneous passage, persistent pain despite adequate analgesia, persistent obstruction and renal insufficiency as indications for ureteral stone removal.

Tests needed before treatment

CT KUB

A non-contrast CT KUB is usually the best test for a ureteric stone. It shows:

  • Exact stone size.
  • Stone location.
  • Kidney swelling.
  • Stone hardness in Hounsfield units, or HU.
  • Other kidney stones.
  • Whether ESWL may work.

EAU notes that CT findings such as stone density, stone burden, skin-to-stone distance and hydronephrosis can affect SWL success.

Urine routine and culture

These tests check for pus cells, blood and infection. If infection is present with obstruction, treatment priorities change.

Blood tests

Serum creatinine checks kidney function. CBC may show infection. Calcium, uric acid and metabolic testing may be advised in recurrent stone formers.

Treatment option 1: Medicines and observation

Medicines may be used for selected small stones.

Your doctor may advise:

  • Pain control medicines.
  • Anti-vomiting medicines.
  • Hydration according to thirst.
  • Urine straining to catch the stone.
  • Follow-up ultrasound or CT.
  • Return immediately if fever, vomiting or severe pain occurs.

Do not force excessive water during severe stone pain. If the ureter is blocked, overhydration can worsen pain.

Treatment option 2: Medical expulsive therapy

Medical expulsive therapy means medicines that relax the ureter and may help stone passage.

This works best for distal ureteric stones, meaning stones near the bladder. NICE recommends considering alpha blockers for distal ureteric stones under 10 mm.

For a mid ureteric stone, these medicines may be considered in selected patients, but they should not delay URSL, ESWL or drainage if there is fever, repeated severe pain, obstruction or kidney function concern.

Treatment option 3: URSL with laser

URSL, or ureteroscopic lithotripsy, is one of the most common treatments for a mid ureteric stone.

A thin telescope is passed through the urinary passage into the bladder and then into the ureter. There is usually no skin cut. The stone is seen directly and broken using laser. Fragments may be removed or allowed to pass.

URSL is often preferred when:

  • The stone is 8-10 mm or larger.
  • Pain is repeated or severe.
  • The stone is stuck or impacted.
  • Kidney swelling is significant.
  • ESWL is unlikely to work.
  • The patient needs faster stone clearance.
  • The patient is obese or stone targeting is difficult.
  • Previous ESWL has failed.

EAU advises that patients should be informed that ureteroscopy has a better chance of achieving stone-free status with a single procedure, while SWL has lower morbidity but may need more retreatment.

Treatment option 4: ESWL shock wave treatment

ESWL, or shock wave lithotripsy, breaks the stone using shock waves from outside the body. The broken pieces pass in urine.

ESWL may be suitable when:

  • The stone is small, usually under 10 mm.
  • The stone is visible and targetable.
  • There is no fever or active infection.
  • Pain is controlled.
  • Kidney swelling is not severe.
  • The patient understands repeat sessions may be needed.

ESWL may be less suitable when:

  • The stone is hard on CT.
  • The stone is impacted.
  • Targeting is difficult.
  • The patient has obesity or long skin-to-stone distance.
  • There is severe obstruction.
  • There is infection with blockage.
  • The patient needs quicker, more reliable clearance.

URSL vs ESWL for mid ureteric stone

Point URSL / laser ureteroscopy ESWL
Method Telescope enters ureter and laser breaks stone Shock waves break stone from outside
Skin cut No skin cut No skin cut
Anaesthesia Usually spinal or general Varies by centre
Stone clearance Often better in one sitting May need repeat sessions
Best for Larger, stuck, hard or painful stones Smaller, visible, non-impacted stones
Stent need Sometimes Usually not routine
Limitation More invasive than ESWL Fragments must pass; failure possible

For many mid ureteric stones that are large, stuck or repeatedly painful, URSL gives a more predictable one-procedure result.

Is a DJ stent needed?

A DJ stent is a soft temporary tube placed from the kidney to the bladder. It keeps urine flowing while swelling settles.

A stent may be needed if:

  • The ureter is swollen after stone removal.
  • The stone was impacted.
  • There is infection risk.
  • There are residual fragments.
  • The ureter needs time to heal.
  • Emergency drainage is needed before definitive stone surgery.

BAUS describes ureteric stent insertion as a telescope-based procedure where a guidewire is passed into the ureter and a stent is placed into position under X-ray guidance.

Common stent symptoms include burning urine, frequency, urgency, blood in urine and flank discomfort while passing urine. These are usually temporary and improve after stent removal.

NICE advises that post-ureteroscopy stenting should not be routine for adults with ureteric stones under 20 mm, but the final decision depends on operative findings.

Emergency situation: infected blocked kidney

A blocked kidney with fever is different from ordinary stone pain. It can become serious quickly.

In this situation, the first step may be drainage by:

  • DJ stent insertion, or
  • Percutaneous nephrostomy, a tube placed directly into the kidney from the back.

The stone is usually treated later after infection settles.

Recovery after URSL

Most patients go home the same day or next day.

Common temporary symptoms include:

  • Mild burning urine.
  • Blood-tinged urine.
  • Increased urine frequency.
  • Flank discomfort.
  • Stent-related symptoms, if a stent is placed.

Many patients return to desk work within a few days, depending on pain, fever risk and stent symptoms. Heavy lifting, long travel, intense exercise and sexual activity should be discussed with your doctor based on your recovery.

Preventing another ureteric stone

After treatment, prevention matters.

General steps include:

  • Drink enough water to keep urine pale.
  • Reduce excess salt.
  • Avoid very high animal-protein intake.
  • Do not unnecessarily stop dietary calcium.
  • Add lemon water if suitable.
  • Analyse the stone if it is passed or removed.
  • Do metabolic evaluation for recurrent stones.

NICE advises adults with urinary stones to drink about 2.5-3 litres of water per day, avoid excess salt, maintain normal calcium intake and consider stone analysis and serum calcium testing.

What to bring for consultation

Bring:

  • CT KUB report and images.
  • Ultrasound KUB report.
  • Urine routine report.
  • Urine culture report, if done.
  • Serum creatinine.
  • CBC.
  • Previous stone surgery records.
  • Current medicines, especially blood thinners.
  • Fever records and antibiotic prescriptions.
  • Any passed stone sample.

Questions to ask your urologist

  • What is the exact size and location of my stone?
  • Is my kidney swollen?
  • Is it safe to wait?
  • What is the chance this stone will pass?
  • Is URSL or ESWL better for me?
  • Will I need a DJ stent?
  • When can I return to work?
  • How can I prevent another stone?

FAQs

What is the best mid ureteric stone treatment?

The best treatment depends on stone size, pain, infection, kidney swelling and kidney function. Small uncomplicated stones may pass naturally. Larger, stuck, painful or obstructing stones often need URSL with laser or sometimes ESWL.

Can a 6 mm mid ureteric stone pass naturally?

Yes, it may pass in some patients. But waiting is safer only if there is no fever, pain is controlled, creatinine is normal and kidney swelling is not severe.

Is URSL better than ESWL for a mid ureteric stone?

URSL is often more reliable in one sitting, especially for larger, hard or stuck stones. ESWL is less invasive but may need repeat sessions and the fragments must pass naturally.

Does a DJ stent remove the stone?

No. A DJ stent drains urine and relieves blockage. It does not break or remove the stone. Definitive stone treatment may still be needed.

When is a mid ureteric stone dangerous?

It is dangerous if there is fever, chills, uncontrolled pain, vomiting, reduced urine output, rising creatinine, severe hydronephrosis or a single kidney. These signs need urgent care.

Can medicines dissolve a mid ureteric stone?

Most calcium stones do not dissolve with medicines. Some uric acid stones may be managed with urine alkalinisation under supervision, but this depends on stone type, urine pH and whether urgent treatment is needed.

Related reading

References

Note: This information is for educational purposes only and is not a substitute for medical advice. Please consult your doctor for any symptoms.