Ureteric stones are a common cause of sudden, severe pain in the side or back. This guide explains the symptoms, how likely a stone is to pass on its own, the warning signs that need urgent care, how doctors confirm it and the main treatment options, based on NHS, NICE, EAU and NIDDK guidance.
What is a ureteric stone?
The ureter is the thin tube that carries urine from each kidney down to the bladder. A ureteric stone (ureter stone) is usually a kidney stone that has left the kidney and moved into this tube. Because the ureter is narrow, a stone can block the flow of urine and stretch the kidney, causing pain. To learn how stones form, see our guide to kidney stones.
Symptoms of a stone in the ureter
The main symptom is renal colic: sudden, severe pain that comes and goes in waves. According to the NHS, the pain usually starts in the side of the abdomen or the lower back and may spread to the groin, the testicles or the area around the vaginal opening.
- Blood in the urine: NIDDK describes urine that may look pink, red or brown (haematuria).
- Nausea or vomiting.
- Needing to pass urine often, or cloudy urine.
- Fever or chills, which can signal infection.
Will a ureteric stone pass on its own?
Many small stones do. NIDDK says small stones may pass without treatment, and the NHS notes that passing a stone can take a few weeks. Size and position matter. According to a 2017 evidence review in The Journal of Family Practice, based on an AUA/EAU guideline panel meta-analysis, stones smaller than 5 mm passed on their own in 68% of patients, and stones of 5 to 10 mm in 47%. Stones low in the ureter, near the bladder, passed more often than those higher up.
The European Association of Urology (EAU) says watchful waiting with regular check-ups is reasonable for informed patients without complications. Your doctor may also suggest medicine that relaxes the ureter; the EAU lists this as an option for stones in the lower ureter larger than 5 mm, and NICE says it can be considered for lower ureteric stones smaller than 10 mm. Your doctor decides whether this suits you. Read more about passing a kidney stone.
Treatment is usually needed when the stone is unlikely to pass, when pain continues despite pain relief, when the blockage persists, or when kidney function is at risk. NICE advises offering treatment within 48 hours to adults with a ureteric stone whose pain is ongoing and not tolerated, or whose stone is unlikely to pass.
When is it an emergency?
The EAU describes a blocked kidney with signs of urinary infection, or with no urine being passed (anuria), as a urological emergency. Get urgent medical help if you have stone symptoms together with any of the following:
- Fever, sweats, shivering or feeling very unwell, which may mean infection behind a blockage.
- Only one working kidney, a transplanted kidney or existing kidney disease.
- Passing very little or no urine, or suspected blockage on both sides.
- Pain that does not settle despite pain relief.
- Vomiting that stops you keeping fluids down.
These signs follow NHS Lanarkshire referral criteria and NHS and NIDDK advice.
How is a ureteric stone diagnosed?
Tests usually include:
- Urine test: NIDDK says it can show blood in the urine and signs of infection.
- Blood tests: to check kidney function and signs of infection.
- CT scan (CT KUB): NICE recommends low-dose non-contrast CT within 24 hours for adults with suspected renal colic. It shows the stone’s size, position and any blockage.
- Ultrasound: NICE and the NHS recommend ultrasound first for pregnant women and for children.
Treatment options compared
The choice depends on the stone’s size and position, symptoms, infection and general health. Your urologist will explain what fits you.
| Option | What it involves | When it may be considered |
|---|---|---|
| Watchful waiting, with or without medicine | Pain relief, fluids, regular check-ups and sometimes medicine to relax the ureter | Small stones, controlled pain, no infection or serious blockage |
| shockwave lithotripsy | Shock waves from outside the body break the stone into small pieces that pass in the urine | NICE recommends it for adults with ureteric stones under 10 mm |
| Ureteroscopy | A thin scope is passed through the urethra and bladder into the ureter to remove or break the stone, usually under anaesthesia | NICE recommends it for ureteric stones of 10 to 20 mm; also an option for smaller stones |
| Stent or nephrostomy | A tube inside the ureter, or through the skin into the kidney, drains urine past the blockage | Urgent drainage of a blocked, infected kidney |
According to the EAU, ureteroscopy has a better chance of clearing the stone in one procedure but a higher complication rate than shockwave treatment. NIDDK says people usually go home the same day. Learn more about flexible ureteroscopy.
If the kidney is blocked and infected, the EAU advises urgent drainage first with a ureteral stent or a nephrostomy tube, and delaying the stone treatment until the infection has cleared.
Ureteric stones in pregnancy
In pregnancy, the EAU recommends ultrasound as the preferred scan, with MRI as a second option. If treatment becomes necessary, a ureteral stent or nephrostomy tube are common first options, and ureteroscopy is a reasonable alternative to avoid long-term drainage. The EAU notes stents collect deposits faster in pregnancy, so follow-up matters.
After the stone has passed or been treated
The NHS may ask you to collect a passed stone so it can be tested, which helps find its cause. To lower the chance of new stones, the NHS advises adults to drink 2.5 to 3 litres of water a day unless a doctor advises otherwise. Other prevention steps depend on the stone type.
Frequently asked questions
What is the difference between a kidney stone and a ureteric stone?
Usually it is the same stone in a different place. A kidney stone sits inside the kidney; a ureteric stone has moved into the ureter. Stones in the ureter more often cause sudden severe pain because they can block urine flow.
How long does it take a ureteric stone to pass?
It varies with the stone's size and position. The NHS says passing a stone can take a few weeks. Your doctor will usually arrange check-ups and may advise treatment if the stone has not moved or symptoms continue.
Does a 5 mm ureteric stone pass on its own?
Many do. According to a 2017 evidence review in The Journal of Family Practice, based on an AUA/EAU guideline panel meta-analysis, stones under 5 mm passed on their own in 68% of patients and stones of 5 to 10 mm in 47%. Position matters too, so your urologist judges your chances.
Is blood in the urine normal with a ureteric stone?
It is a common sign of a stone; NIDDK says urine may look pink, red or brown. Even so, blood in the urine should always be checked by a doctor, because it can have other causes.
When should I go to the emergency department?
Go urgently if pain does not settle with pain relief, if you have fever or shivering, if you pass very little or no urine, if you have only one kidney, or if vomiting stops you keeping fluids down.
Will I need a stent after ureteroscopy?
Not always. NICE advises against routinely placing a stent after ureteroscopy for ureteric stones smaller than 20 mm in adults. Your urologist decides based on how the procedure went, swelling, infection and other factors.
Sources
- Kidney stones – NHS
- Symptoms & Causes of Kidney Stones – NIDDK
- Treatment for Kidney Stones – NIDDK
- Renal and ureteric stones: assessment and management (NG118) – NICE
- EAU Pocket Guidelines on Urolithiasis 2026 – European Association of Urology
- Ureteral calculi: What should you consider before intervening? – The Journal of Family Practice
- Renal Colic Referral Pathway – NHS Lanarkshire (Right Decisions)
Book a consultation
Prof. Samir Al-Samarrai and Dr. Amer Mousa assess urological conditions at Prof. Al-Samarrai Medical Center, Dubai Healthcare City, and discuss the options that suit your case. Medical consultations are confidential.
Read more: Urologist in Dubai: doctors, services, insurance and booking
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