A stone stuck in the ureter means a kidney stone has moved into the urine tube between the kidney and bladder and is partly or completely blocking urine flow. It can cause severe side pain, vomiting, burning urine, frequent urination or blood in urine. Some small ureter stones pass naturally with medicines and follow-up. But fever, chills, uncontrolled pain, repeated vomiting, reduced urine, single kidney, high creatinine or kidney swelling can be dangerous and needs urgent urology care. An infected blocked kidney is an emergency.

What is a stone stuck in the ureter?

The ureter is the narrow tube that carries urine from the kidney to the bladder. A stone may form inside the kidney and then move down into the ureter. Because the ureter is narrow, the stone can get stuck.

When urine cannot drain properly, pressure builds up inside the kidney. This causes severe cramp-like pain called renal colic or ureteric colic.

A stone may be stuck in the:

Stone stuck in ureter: quick decision guide

This is the main point: the decision is not based only on stone size. A 5 mm stone with fever can be more urgent than a larger stone without infection.

Symptoms of a stone stuck in ureter

Symptoms can start suddenly and may come in waves.

Common symptoms include:

• Severe pain in the side, back or loin.
• Pain moving to the lower abdomen, groin, testicle or labia.
• Nausea or vomiting.
• Blood in urine.
• Burning while passing urine.
• Frequent urge to pass urine.
• Pain at the tip of the penis in some men.
• Restlessness during pain episodes.

Lower ureter stones can mimic a urine infection because they irritate the bladder area.

Will a stone stuck in the ureter pass naturally?

Sometimes, yes.

The chance of passing naturally depends on:

• Stone size.
• Stone location.
• Degree of kidney swelling.
• Pain severity.
• Fever or infection.
• Kidney function.
• Whether the patient can return for follow-up.

Observation may be safe in selected patients who have no infection, no refractory pain and no worsening kidney function. EAU recommends periodic evaluation if active removal is not needed for a newly diagnosed small ureteric stone.

What your CT KUB report means

A CT KUB report helps the urologist decide whether to wait, give medicines, do ESWL, perform URSL or place a DJ stent.

BAUS notes that CT helps confirm the stone and gives important details such as stone site, number, size and estimated hardness, all of which influence treatment choice.

Tests needed for ureter stone

Urine routine

This checks blood, pus cells and infection clues.

Urine culture

Important if there is fever, burning urine, pus cells or planned surgery.

Serum creatinine

Checks kidney function.

CBC and CRP

Useful if infection or inflammation is suspected.

Ultrasound KUB

Can show kidney swelling and some stones. It is also useful for follow-up.

CT KUB / NCCT KUB

A non-contrast CT KUB is usually the most accurate scan for ureter stones. NICE recommends urgent low-dose non-contrast CT within 24 hours for adults with suspected renal colic. In pregnancy, ultrasound is used first.

Treatment for stone stuck in ureter

Treatment has three broad paths:

1. Observation and medicines
2. Planned stone removal
3. Emergency drainage

The safest option depends on the report and the patient’s condition.

1. Pain relief and observation

Pain control is the first step. Medicines may include anti-inflammatory painkillers, paracetamol or other medicines depending on kidney function, acidity, BP, blood thinners and other health issues.

Observation may be advised if:

• Stone is small.
• Pain is controlled.
• No fever.
• No repeated vomiting.
• Kidney function is normal.
• Kidney swelling is mild or stable.
• Follow-up imaging is possible.

Do not keep taking repeated pain injections without knowing stone size, hydronephrosis and creatinine status.

2. Medical expulsive therapy

Some selected patients with lower ureter stones may be given medicines that relax the ureter and help the stone pass. This is called medical expulsive therapy.

EAU states that alpha-blockers may be offered as one treatment option for distal ureter stones larger than 5 mm, especially 5-10 mm stones, when conservative management is appropriate. NICE recommends considering alpha-blockers for distal ureteric stones less than 10 mm, noting off-label use.

This treatment should not delay urgent care if there is fever, high creatinine, severe obstruction or uncontrolled pain.

3. URSL / ureteroscopy for ureter stone

URSL, or ureteroscopic lithotripsy, is a common endoscopic surgery for ureter stones. A thin telescope is passed through the urine passage into the bladder and ureter. The stone is seen directly, broken with laser or another energy source, and removed or allowed to pass as small fragments.

URSL may be advised when:

• The stone is unlikely to pass.
• Pain keeps recurring.
• The stone is larger.
• There is persistent blockage.
• Kidney function is affected.
• ESWL is unsuitable or has failed.
• Faster stone clearance is needed.

NICE recommends URS as a main option for adult ureteric stones 10-20 mm, while smaller stones may be treated with SWL first in suitable cases. NICE also recommends offering surgical treatment within 48 hours for adults with ureteric stones and renal colic if pain is ongoing and not tolerated or the stone is unlikely to pass.

4. ESWL / shockwave lithotripsy

ESWL uses shockwaves from outside the body to break the stone into smaller pieces. It may be suitable for selected ureter stones, especially when the stone is targetable and not too hard or large.

Advantages:

• No telescope through the urinary passage.
• Less invasive than surgery.
• Useful for selected upper ureter stones.

Limitations:

• May need more than one sitting.
• Fragments still need to pass.
• Not ideal for every stone size or location.
• Not used in pregnancy.
• May work poorly for hard stones or difficult targeting.

EAU notes that URS has a better chance of making a patient stone-free in a single procedure, while SWL has lower invasiveness but may need retreatment depending on the case.

5. DJ stent for ureter stone

A DJ stent is a soft tube placed from the kidney to the bladder. It allows urine to drain around the blocked area.

A DJ stent may be needed when:

• There is infection with blockage.
• Pain is not settling.
• Kidney function is affected.
• Definitive stone surgery must be delayed.
• The ureter is swollen or tight.
• Temporary drainage is safer than immediate stone removal.

A DJ stent is not always the final treatment. In many cases, it relieves obstruction first, and the stone is treated later.

6. Nephrostomy tube

A nephrostomy is a tube placed directly into the kidney from the back to drain urine. It may be used when urgent drainage is needed and stenting is not suitable or not possible.

For infected obstruction, EAU considers both ureteric stenting and nephrostomy effective drainage methods. The key is urgent drainage, antibiotics and delaying stone removal until infection is controlled.

Can drinking lots of water push the stone out?

Drink normal fluids unless your doctor has restricted you. Do not force excessive water during severe pain, vomiting or complete obstruction. Too much fluid during obstruction can increase pressure and worsen pain.

Once pain settles and the doctor confirms it is safe, hydration is important for future stone prevention.

Recovery after ureter stone treatment

If the stone passes naturally

Pain usually settles after the stone passes. But follow-up imaging may still be needed to confirm that kidney swelling has resolved.

After URSL

Many patients go home the same day or next day, depending on pain, fever risk, anaesthesia and stent placement. Mild burning, frequency, blood-stained urine and flank discomfort can occur.

After DJ stent

Common stent symptoms include:

• Frequent urination.
• Urgency.
• Burning urine.
• Mild blood in urine.
• Flank pain while passing urine.
• Lower abdominal discomfort.

These symptoms are common. Fever, inability to pass urine, severe bleeding or worsening pain is not normal.

How to prevent another ureter stone

Prevention depends on the stone type and recurrence risk.

General advice includes:

• Drink enough fluids through the day.
• Reduce excess salt.
• Avoid unnecessary calcium restriction.
• Avoid very high animal-protein intake if stone risk is high.
• Send passed or removed stone for analysis.
• Do metabolic evaluation if stones are recurrent, bilateral, large, unusual or occur at a young age.

NICE advises adults with renal or ureteric stones to discuss diet and fluid intake, including 2.5-3 litres of water per day, avoiding carbonated drinks, reducing salt and maintaining normal dietary calcium.

What to bring for consultation

Bring:

• USG KUB report.
• CT KUB / NCCT KUB report and images/CD.
• Urine routine report.
• Urine culture report, if done.
• Serum creatinine report.
• CBC/CRP if fever was present.
• Current medicines.
• Blood thinner details, if any.
• Diabetes/BP reports.
• Previous stone surgery records.
• Recent discharge summary, if admitted.
• Any passed stone fragment for analysis.

FAQs

Related reading

• URSL Surgery for Ureteric Stone: Procedure, DJ Stent and Recovery
• DJ Stent for Kidney Stone: Why It Is Placed
• Stone with Hydronephrosis: What It Means
• Can a 3 mm Kidney Stone Pass Naturally?
• Upper Ureteric Stone Treatment
• Kidney Stone Treatment in Latur

References

• European Association of Urology. EAU Guidelines on Urolithiasis https://uroweb.org/guidelines/urolithiasis/chapter/guidelines
• NICE Guideline NG118. Renal and ureteric stones: assessment and management https://www.nice.org.uk/guidance/ng118/chapter/recommendations
• British Association of Urological Surgeons. Kidney stones patient information https://www.baus.org.uk/patients/conditions/6/kidney_stones/
• British Association of Urological Surgeons. Ureteric stent insertion patient information https://www.baus.org.uk/patients/information_leaflets/183/ureteric_stent_insertion