Ureteric stones typically form in the kidneys and then migrate down into the ureter. The primary causes and risk factors include:
1. Kidney Stones: o Most ureteric stones are initially formed in the kidneys (renal stones) from a build-up of certain substances in the urine, such as calcium, uric acid, oxalate, or cystine.
o When these stones move into the ureter, they are referred to as ureteric stones.
2. Dehydration:
o Insufficient water intake can lead to concentrated urine, increasing the risk of stone formation.
3. Dietary Factors:
o High intake of salt, sugar, or animal protein can increase the likelihood of stone formation. Conversely, a diet low in fiber and high in oxalate (found in foods like spinach, nuts, and chocolate) can contribute to certain types of kidney stones.
4. Metabolic Conditions:
o Conditions such as hypercalciuria (excess calcium in the urine), hyperoxaluria (excess oxalate), or gout (high uric acid levels) increase the risk of stone formation.
5. Family History:
o A family history of kidney stones may increase the risk of developing ureteric stones.
6. Obesity:
o Being overweight or obese can increase the risk of stone formation, likely due to changes in urine composition and an increase in risk factors like dehydration or metabolic disturbances.
7. Certain Medical Conditions:
o Chronic conditions such as inflammatory bowel disease (IBD), urinary tract infections (UTIs), hyperparathyroidism, and renal tubular acidosis can increase the risk of stone formation.
8. Medications:
o Some medications, such as diuretics, antacids containing calcium, or chemotherapy drugs, can contribute to stone formation.

The symptoms of a ureteric stone largely depend on its size, location, and whether it causes any obstruction or injury to the urinary tract. Common symptoms include:
1. Severe Pain (Renal Colic):
o Flank pain: Pain in the side or lower back, typically on one side, is the hallmark symptom of a ureteric stone. The pain is often described as sharp and severe and may come in waves.
o Radiating pain: Pain can radiate down to the lower abdomen, groin, and even the genital area as the stone moves down the ureter.
2. Hematuria (Blood in Urine):
o A ureteric stone can cause microscopic or gross hematuria (visible blood in the urine), due to irritation or injury to the lining of the urinary tract.
3. Dysuria (Painful Urination):
o As the stone approaches the bladder, it may cause pain or discomfort while urinating.
4. Frequent Urination:
o The presence of a stone in the lower ureter or near the bladder can cause an increased urgency or frequency of urination.
5. Nausea and Vomiting:
o Severe pain from a ureteric stone may be accompanied by nausea and vomiting due to the body’s response to intense pain and the autonomic nervous system’s effects.
6. Reduced Urine Output:
o In some cases, if the stone causes a blockage in the ureter, there may be a decreased urine output or even anuria (complete lack of urination) in extreme cases.
7. Fever and Chills:
o If the stone causes an infection or obstructs urine flow, it can lead to a urinary tract infection (UTI) or pyelonephritis (kidney infection), leading to fever, chills, and more systemic symptoms.

Diagnosis involves a combination of clinical evaluation and imaging studies. Key diagnostic methods include:
1. Clinical History and Symptoms:
o The doctor will assess symptoms, risk factors, and the patient’s medical history.
2. Urinalysis:
o A urine test can identify blood in the urine (hematuria), signs of infection, and the presence of crystals that might indicate stone formation.
3. Imaging:
o Non-contrast CT scan: The most sensitive and commonly used imaging technique to diagnose ureteric stones. It provides a detailed view of the kidneys, ureters, and bladder, allowing the identification of even small stones.
o Ultrasound: This is a non-invasive option used to detect hydronephrosis (swelling of the kidney due to urine backup) or large stones, though it may not detect small stones as accurately as a CT scan.
o X-ray: An abdominal KUB (Kidney, Ureter, Bladder) X-ray can show radiopaque stones (e.g., calcium-based stones), though it is not effective for all stone types.
o MRI: In rare cases or when a CT scan is not suitable, an MRI may be used, but it is generally less effective than CT in diagnosing ureteric stones.
4. Stone Analysis:
o If a stone passes or is surgically removed, its composition can be analyzed in the laboratory to help determine the type of stone (e.g., calcium oxalate, uric acid, struvite), which can guide treatment and prevention.

Treatment depends on the size and location of the stone, the severity of symptoms, and whether the stone is causing any complications. Treatment options include:
1. Conservative Management (For Small Stones):
• Observation: If the stone is small (less than 5 mm), and not causing significant obstruction or infection, it may pass on its own with time.
• Hydration: Increasing fluid intake can help flush out small stones.
• Pain management: Over-the-counter pain relievers (e.g., ibuprofen or acetaminophen) can be used to manage mild to moderate pain.
• Alpha-blockers: Medications like tamsulosin (Flomax) can help relax the smooth muscles in the ureter, making it easier for the stone to pass.
2. Extracorporeal Shock Wave Lithotripsy (ESWL):
• ESWL uses sound waves to break larger stones into smaller pieces that can be passed in the urine.
• It is a non-invasive procedure and is commonly used for stones in the kidney or upper ureter.
3. Ureteroscopy:
• This is a procedure where a flexible or rigid tube (ureteroscope) is passed through the urethra and bladder into the ureter to locate and remove or break up the stone.
• If the stone is caught in a narrow part of the ureter, it can be directly removed or broken into smaller pieces using a laser or other devices.
• Ureteroscopy is typically used for stones in the middle or lower ureter.
4. Percutaneous Nephrolithotomy (PCNL):
• This is a more invasive procedure used for large stones (typically larger than 2 cm) or when other methods fail. It involves making a small incision in the back to directly remove the stone from the kidney or upper ureter.
5. Surgical Removal:
• In rare cases, when other treatments fail or if the stone is very large, traditional open surgery may be required to remove the stone.
6. Antibiotics:
• If a urinary tract infection is present or if the stone causes a blockage that leads to an infection, antibiotics may be prescribed to treat the infection.
7. Prevention:
• Dietary changes: Reducing sodium, animal protein, and oxalate-rich foods while increasing water intake can help prevent stone formation.
• Medications: In some cases, medications may be prescribed to help prevent recurrence. These might include diuretics or phosphate binders depending on the type of stone.
• Monitoring: Regular follow-ups and imaging may be necessary to monitor for the formation of new stones, especially in patients with a history of recurrent stones.