Important parameters in the management of ureteral stones are the size, number of stones and their composition. Stones measuring up to 6mm in diameter are frequently expelled automatically. Medication can also accelerate the elimination of ureteral stones and can be administered to patients without contraindications. Depending on the composition of the stone, oral treatment can be administered for dissolution of the stone. In cases of bigger ureteral stones or failure of conservative therapy the following minimally invasive approaches can considered:

– Extracorporeal shock wave lithotripsy
The majority of patients have an indication for extracorporeal lithotripsy. But the success of the method depends on many factors including the size, location, composition and hardness of the stone. In addition, in important role predicting the outcomes is the patient’s body mass (i.e obesity). During extracorporeal lithotripsy, the patient lies on a device called Lithotripter. Fluoroscopy is used to identify and target the stone. The shock waves are generated outside the body and directed to the target (in this case stone). The latter leads to the fragmentation of the stone. Thereafter, the fragments are expelled with the urine. The procedure usually does not require any anesthesia. The duration of the procedure is 45-60 minutes. Patients can then go home if no side effects are observed. During the first post-procedural hours patients can have some minor discomfort or bloody urine (hematuria). Serious complications are extremely rare after shock wave lithotripsy.

– Endoscopic lithotripsy
This method is performed by the introduction of a tool called ureteroscope through the urethra and bladder into the ureter. The stone is identified and fragmented or dusted using a laser lithotripsy device.The generated fragments are removed by using a special endoscopic basket. In most of the cases stents are placed in the ureters in the end of the surgeries allowing easier passage of the stone fragments. It is worth noting that there are two types ureteroscopes depending on the flexibility of the instrument. These types include the rigid and flexible ureteroscopes. The flexible ureteroscope can also be used to treat kidney stones. The use of ureteroscope by an experienced urologist gives solutions to many problems with minimal burden to the health of the patient. Stones that have failed conservative or extracorporeal lithotripsy treatment are prime indications for endoscopic lithotripsy. Practically, stone in any location (and kidney stone) may be treated with this method. The patient is usually dismissed from the hospital the next day after the surgery. If a ureteral stent is placed during the surgery patients are advised to return in 3-4 weeks for its. The removal procedure is done under local anesthesia, lasts about 5 minutes and is not painful.The main postoperative complications of ureteroscopyare hematuria and urinary tract infection leading to prolonged hospitalization. Symptoms such as urinary frequency, minor hematuria or minor discomfort during urination in postoperative period are generally associated with ureteral stents and pass when the stents are removed.