From the Research
The treatment for a patient with calculus at the ureterovesicular junction typically involves medical expulsive therapy (MET) with alpha-blockers such as tamsulosin 0.4 mg daily for 2-4 weeks to facilitate stone passage, as recommended by recent guidelines 1. Pain management is essential, using NSAIDs like ibuprofen 600 mg every 6 hours or ketorolac 10 mg every 6 hours, with opioids reserved for breakthrough pain. Adequate hydration should be maintained with 2-3 liters of fluid daily. If the stone is small (less than 5-6 mm), watchful waiting with MET is appropriate as there's a high likelihood of spontaneous passage. For larger stones, persistent pain, infection, renal impairment, or failure to pass after 4-6 weeks, intervention is necessary. Options include:
- Ureteroscopy with laser lithotripsy, which has a high success rate and low morbidity 2, 3
- Extracorporeal shock wave lithotripsy (ESWL) Ureteroscopy is often preferred for distal ureteral stones due to higher success rates. Alpha-blockers work by relaxing the smooth muscle of the ureter, particularly at the ureterovesical junction, which widens the ureteral lumen and facilitates stone passage while reducing pain episodes. The use of devices like the Stone Cone can help prevent stone retropulsion during ureteroscopic lithotripsy, minimizing the need for additional procedures 4. It's worth noting that the composition of the stone, such as uric acid stones, may require specific treatment approaches, including urine alkalinization and dietary modifications 5. However, for most patients with calculus at the ureterovesicular junction, the above approach is the most appropriate course of treatment, prioritizing morbidity, mortality, and quality of life as the outcome.