How to treat stones at the ureteral transition?

Patient's question:

What should I do if there is a stone at the ureteral transition? 12mm-9mm

Doctor's answer:

Hello: Ureteral stones measuring 12mm-9mm can be easily diagnosed through clinical ultrasound. Generally, kidney stones that fall into the ureter are diagnosed as ureteral stones. They often cause ureteral obstruction, leading to renal pelvis dilation and hydronephrosis. If the ureteral stones are not promptly removed to alleviate the obstruction, it may result in kidney damage or failure. In the early stages, symptoms often include lower back pain and severe renal colic, causing significant distress to the patient. Lower ureteral stones can also cause pain in the penis, testicles, and perineum. Accompanying symptoms may include nausea and vomiting. It is recommended to use the non-invasive extracorporeal shock wave lithotripsy (ESWL) machine as the primary treatment option - [Registration Number = Yu Food and Drug Administration (Approval) 2012 No. 2260216)] for stone removal. Early treatment is crucial for better stone removal results, typically taking 1-3 hours to expel the stones without hospitalization.
First, let's clarify that the extracorporeal shock wave lithotripsy (ESWL) machine is a non-invasive, innovative stone removal device and technology. Its principle is entirely different from that of extracorporeal shock wave lithotripsy (ESWL). The advantage of the ESWL machine lies in its lack of organ damage, thorough stone removal, minimal patient discomfort, and easy acceptance. In contrast, extracorporeal shock wave lithotripsy (ESWL) can cause organ damage and is more painful.
The ESWL technology employs high-frequency superconducting fluid dynamic shock wave lithotripsy, combined with three-dimensional positioning assistance from large digital ultrasound. It offers precise positioning, rapid stone removal, and is particularly effective for bile duct stones, ureteral stones, and allows immediate discharge after treatment. It is especially effective in completely removing from intrahepatic bile ducts. The most prominent feature of this device is its user-friendly operation, thorough stone removal for various types of stones, broad applicability, minimal side effects on the body, painless treatment process, no need for hospitalization, and low treatment costs, making it highly acceptable to patients. It is a reliable, effective, simple, and practical treatment device with unique equipment and technical advantages. Therefore, it is currently the best choice for treating various types of stones.
The non-invasive extracorporeal shock wave lithotripsy machine is the optimal treatment for kidney and ureteral stones under 10mm. Generally, after several treatments, stones can be completely removed. For larger stones, the principle of first crushing and then removing the stones can be applied to achieve complementary advantages. However, for ureteral stones, treatment must be delayed for 3-5 days to allow local ureteral congestion and edema to subside before proceeding with stone removal. Generally, stones are relatively easy to remove. With the widespread use of ultrasound, the diagnosis of ureteral stones is now more timely and accurate. Small stones entering the ureter are usually detected early, providing the best conditions for ESWL treatment. For stones that have been lodged in the ureter for a long time, removal is more difficult and may require surgical or ureteroscopic lithotripsy. At the same time, it is essential to provide patients with the latest measures for early stone removal to avoid excessive, organ-damaging, ineffective, painful, time-consuming, and costly treatments.
The indications and scope of treatment for the non-invasive extracorporeal shock wave lithotripsy machine are as follows:
(1) For kidney and ureteral stones smaller than 1.2cm, extracorporeal shock wave lithotripsy (ESWL) should be the first choice for stone removal. It causes no kidney damage, ensures thorough stone removal, is safe and painless, and avoids the side effects of extracorporeal shock wave lithotripsy (ESWL). If the stone diameter exceeds 1.2cm, extracorporeal shock wave lithotripsy (ESWL) should first be used for crushing, followed by ESWL for complete stone removal, achieving complementary advantages.
(2) This device is particularly suitable for acute ureteral stones and the resulting renal pelvis dilation, hydronephrosis, ureteral obstruction, ureteral dilation, and renal colic. It can quickly remove ureteral stones, alleviate immediate pain, and rapidly relieve symptoms, making it the preferred treatment for ureteral stones.
(3) For patients with multiple kidney stones on the same side accompanied by ureteral stones, the ureteral stones should be removed first, followed by the removal of multiple kidney stones, to prevent the formation of a "stone street" in the ureter.
(4) For large kidney stones that remain in the lower pole of the kidney or renal pelvis after ESWL, small residual stones are the optimal indication for ESWL for thorough stone removal. This is because the handheld high-frequency superconducting shock wave transducer can directly contact the stones in the lower pole of the kidney, moving them into the renal pelvis and ureter for removal.
(5) For the treatment of various types of stones, if complications such as urinary tract infections lead to pyelonephritis, ureteritis, cystitis, prostatitis, or urethritis, and if inflammation caused by mucosal congestion and edema affects stone removal, antibiotic treatment must be administered first to resolve inflammation before proceeding with ESWL.
(6) In general, 1-3 ESWL treatments are sufficient to completely remove stones, taking 5-7 days. Patients in good physical condition can undergo continuous treatments, while those with poorer health may need to be treated once every other day. If the patient has poor urinary function or is a carrier of infection, the hospitalization period may be longer. According to clinical observations, Professor Chen Bangjing believes that ESWL is currently the leading new technology for treating stones domestically and internationally. It is the preferred method for treating kidney stones, ureteral stones (which are usually removed within two hours), gallstones, and extrahepatic bile duct stones. Its completely thorough stone removal, lack of organ side effects, and low cost have benefited a vast number of patients. For stones beyond the scope of ESWL, extracorporeal shock wave lithotripsy (ESWL) should be performed first, followed by stone removal. For large kidney cast stones and gallstones, surgical removal is recommended if discovered.
If you need treatment, please contact me or communicate online. Thank you for your cooperation. Professor Chen of Zhoukou Bayi Expert Clinic wishes you a speedy recovery.