Treatment Options for Ureteral Stones and Associated Hydronephrosis

Ureteral stones can lead to a blockage in the ureter, preventing urine produced by the kidneys from draining properly. As a result, urine accumulates in the kidney, leading to a condition known as hydronephrosis — the swelling of the kidney due to a buildup of urine. This condition requires timely medical intervention to prevent long-term kidney damage. Fortunately, several effective treatment strategies are available depending on the size, location, and number of stones.

Non-Surgical Treatment: Extracorporeal Shock Wave Lithotripsy (ESWL)

For smaller stones — typically those under 1 centimeter in diameter — extracorporeal shock wave lithotripsy (ESWL) is often the first-line treatment. This non-invasive procedure uses high-energy sound waves to break the stone into small fragments that can then pass naturally through the urinary tract. Once the obstruction is cleared and urine flow resumes, the accumulated fluid in the kidney gradually drains, allowing hydronephrosis to resolve on its own. ESWL is generally well-tolerated, performed on an outpatient basis, and requires minimal recovery time.

Minimally Invasive Surgical Procedures

When stones exceed 1 cm in size, ESWL may still be considered, but multiple sessions might be necessary, and success rates decrease with larger stone volumes. In such cases, minimally invasive surgical options become more favorable. One widely used approach is ureteroscopic lithotripsy, where a thin, flexible scope is passed through the urethra and bladder into the ureter. Under direct visualization, the stone is fragmented using laser energy or other tools. Following the procedure, a ureteral stent is typically placed to ensure proper drainage of urine, relieve hydronephrosis, and facilitate the passage of remaining stone fragments.

Advantages of Ureteroscopy

This technique offers high success rates, immediate relief of obstruction, and the ability to retrieve stone samples for laboratory analysis. It's especially beneficial for patients with moderate to large stones located in the mid or lower ureter. The stent usually remains in place for several days to weeks, depending on the degree of swelling and healing progress.

Surgical Intervention for Large or Complex Stone Burdens

In cases of very large stones, multiple stones, or "stone streets" (a chain of stone fragments along the ureter), more aggressive treatment may be required. Extracorporeal shock wave lithotripsy is often ineffective in these scenarios due to the volume and density of the stones. Instead, procedures such as laparoscopic ureterolithotomy or even open surgery may be recommended. These approaches involve making a small incision in the abdomen to directly access and remove the stones from the ureter.

When Open Surgery Might Be Necessary

While open surgery is less common today due to advances in minimally invasive techniques, it remains a viable option for complex cases where other methods pose higher risks or have failed. Laparoscopic surgery offers a middle ground — providing direct access with reduced recovery time and fewer complications compared to traditional open procedures.

Regardless of the treatment path, the primary goals are to relieve the urinary obstruction, preserve kidney function, and prevent recurrence. Follow-up imaging, such as ultrasound or CT scans, is crucial to confirm complete stone clearance and resolution of hydronephrosis. Additionally, metabolic evaluation and dietary recommendations may be advised to reduce the risk of future stone formation.