From the Guidelines
The recommended treatment for right hydroureteronephrosis caused by a 2-3 mm distal ureteral calculus includes medical expulsive therapy (MET) with tamsulosin 0.4 mg daily for 4 weeks to facilitate stone passage. This approach is supported by the most recent guidelines, which suggest that conservative management is possible for uncomplicated ureteral stones less than 10 mm in size 1.
Key Considerations
- Pain management should include NSAIDs such as ibuprofen 600 mg every 6 hours or ketorolac 10 mg every 6 hours, with opioids like oxycodone 5 mg every 4-6 hours reserved for breakthrough pain.
- Hydration is essential, with a recommendation to drink 2-3 liters of water daily.
- Most stones of this size (2-3 mm) will pass spontaneously within 1-2 weeks with MET.
- Patients should strain their urine to catch the passed stone for analysis.
Urological Intervention
If complications develop (worsening pain, fever, vomiting, inability to urinate) or if the stone doesn't pass within 4 weeks, urological intervention such as ureteroscopy with laser lithotripsy may be necessary. According to the guidelines, URS is recommended as the first-line treatment for distal ureteral stones greater than 10 mm, but for stones less than 10 mm, URS should be considered as an option 1. The alpha-blocker tamsulosin works by relaxing the smooth muscle of the ureter, increasing the likelihood of spontaneous stone passage and reducing the time to stone expulsion, particularly for distal ureteral stones.
Follow-Up
Follow-up is mandatory if conservative management is chosen, with a maximal duration of conservative treatment of 4 to 6 weeks from the initial clinical presentation 1. The decision to proceed with urological intervention should be based on the patient's symptoms, stone size, and location, as well as the presence of any complications.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Right Hydroureteronephrosis
- The treatment for right hydroureteronephrosis due to a 2-3 mm calculus in the distal right ureter may involve several options, including:
Ureteroscopic Lithotripsy (URSL)
- URSL is a minimally invasive procedure that uses a small endoscope to visualize the stone and break it up into smaller pieces that can be easily passed out of the body 2
- The use of local aminophylline during URSL has been shown to increase the success rate of the procedure and reduce the need for ureteral stents and auxiliary procedures 2
Medical Expulsive Therapy
- Medical expulsive therapy with alpha-blockers has been shown to increase the stone-free rate and reduce the time to stone expulsion in patients with ureteral stones 3, 4
- Alpha-blockers work by relaxing the muscles in the ureter, allowing the stone to pass more easily 3, 4
Observation and Spontaneous Passage
- Observation and spontaneous passage may be an option for patients with small stones (less than 5mm) and minimal symptoms 5
- However, patients with larger stones, significant hydroureteronephrosis, or elevated C-reactive protein levels may be at higher risk of failure and may require more aggressive treatment 5