Treatment of Kidney Stones Located at UVJ (Uretero-vesical junction) in the Ureter
Dr. Alex Shteynshlyuger is a board certified urologist in NYC who specializes in treating men and women with kidney stones and ureteral stones.
What is the UVJ?
The ureterovesical junction (UVJ) is the area where the lower end of the ureter meets the urinary bladder. Any kidney stone that is located in the ureter close to the bladder (within 1-2 cm of the bladder) is called a UVJ stone. This is the most common area for kidney stones to get stuck and cause symptoms because the UVJ is the narrowest point of the ureter. This leads to blockage in the flow of urine and dilation (swelling) of the kidneys and ureter. It is important to seek treatment of UVJ stones from a urologist to prevent compromise in kidney function.
Obstruction due to a UVJ stone can be confirmed by imaging. CT scan is the most common study used to confirm kidney stones; occasionally an ultrasound study can detect a UVJ stone as well.
Symptoms of UVJ Stones
Typical symptoms include back or flank pain, but sometimes only vague abdominal pain is present. Frequent urination and urinary urgency can occur. There may be associated nausea and vomiting. Other symptoms can include blood in the urine. If there is an associated urine infection, fever can occur.
Treatment of UVJ Stones in the Ureter next to the Bladder
The treatment options for UVJ stones depend on the patient’s symptoms and the size of the stone. Conservative treatment includes observation for 4-6 weeks and medical expulsion therapy (MET). MET allows the patient to pass the stone by drinking fluids, controlling pain, and taking prescription medications that relax the ureter and help pass the stone faster. Passing a stone is not an option if you have signs of infection (fever, chills, etc).
A stent may be placed if pain is significant, nausea and vomiting are present, or if the patient has an infection or kidney insufficiency. The stone may later be removed by surgical intervention once the acute symptoms have abated and the infection has cleared. Stent insertion is important in patients with obstructing stones and suspected infection to relieve the obstruction and allow the infected urine to drain out and for antibiotics to penetrate the kidney and treat the infection.
If observation and MET are unsuccessful after 4-6 weeks, the surgical treatment of choice for UVJ stones is ureteroscopy with Holmium laser lithotripsy. Ureteroscopy allows the urologist to access the distal ureter (the bladder end of the ureter).
It should also be noted that although shock-wave lithotripsy (ESWL) is the least invasive intervention and has the lowest complication rate, ureteroscopy is more likely to render a patient stone-free with a single procedure. ESWL has a lower success rate for UVJ stones than for upper ureteral stones or stones within the kidney. In addition, shock-wave lithotripsy is not an option for women of reproduction age with a stone in the distal ureter or UVJ because it is dangerous to use shock wave so near the ovaries.
The Bottom Line:
Ureteroscopy is the first line of therapy for patients with UVJ stones who have failed MET and observation.
You should be aware that a small stone can cause as much pain as a very large ureteral stone. Size of stone does not determine the severity of pain; pain is caused by blockage and a small stone sometimes can cause complete blockage just as a large stone can.
If you need urgent care for kidney stones, call us.