Stone in Right Ureter

I was busy in the operation theater in a fibroadenoma surgery. A call was received from my medicine counterpart regarding a case of pain in the right lower abdomen. He has hinted in his note towards an acute appendicitis. I visited the patient pending a thyroid goiter surgery. The patient only had pain in the right lower abdomen and nothing else viz. vomiting or fever etc. I quickly examined the abdomen there was no pain on pressure on the part and abdomen was calm. These are against an acute appendicitis. However ultrasonogram and blood test were ordered. I returned for the thyroid surgery. When I concluded the surgery the ultrasonogram was ready. That showed a stone in the right side ureter as well as one in the right kidney.

A stone in the right lower ureter always confuses the surgeon with appendicitis. Clinical catch points include lack of typical symptoms of appendicitis i. e. the sequence of event of pain, vomiting and fever. Apart from this patient with a stone in ureter roles about in pain in contrast to appendicitis where patient prefers to remain still. There is lack of pain on pressure over the site, no resistance to pressure and no pain on releasing the pressure. An ultrasonogram clinches the diagnosis where as a plain X-Rays may be helpful in about 40 to 50 percent of cases. An intravenous urogram is confirmatory and gives functional status of kidney and may show other abnormalities in the urinary system if present.

A stone may come out through the urethra if small in size and a plenty of water drinking is advised. A larger stone can be removed either surgically , laparocopically or endoscopically according to the suitability. Stone formation can be prevented by drinking as much water so that there is urine of 2 liters in 24 hours. Supplementation of vitamin A and prompt treatment of urinary infection are important. Long term intake of calcium and steroid should be avoided . A parathyroid hyperactivity if present is to be treated. A congenital abnormality in the urinary system is to be looked at and treated.