Many stones are able to pass all the way out of the urinary tract without any intervention. When stones are symptomatic in the ureter, medical expulsion therapy can be utilized. This is often accomplished with an alpha-blocker such as tamsulosin and these medications help to relax the smooth muscle in the ureter to aid in stone passage. The alpha-blocker may be combined with an anti-inflammatory like ibuprofen and occasional steroids are also used to help decrease inflammation and swelling in the ureter to aid in stone passage.
Larger symptomatic stones that do not pass, require some type of intervention. One option that is often used in the emergent setting is to place a ureteral stent which is a small tube between the kidney and bladder that allows the urine to drain around an obstructing stone. For stones in the kidney or upper part of the ureter, shock wave lithotripsy (SWL) can be used to fragment the stone. This is an outpatient, non-invasive procedure that uses sound waves to fragment the stone into tiny fragments that can then pass on their own. Another option is to perform a ureteroscopy during which a small scope is placed into the ureter and under direct visualization, the stone is removed with a small basket device or a laser (laser lithotripsy) is used to break the stone into smaller pieces which can then pass. For very large stones, sometimes a percutaneous procedure is required. During a percutaneous stone extraction, a small tube is placed directly into the kidney from the back and a scope is placed directly into the kidney and the stone is then broken up with either an ultrasound device or a small pneumatic device (like a jackhammer) and the stone fragments are suctioned out. Unlike the other procedures, a percutaneous procedure requires an overnight hospital stay.