Location of Ureteral Stones. Do They Lodge Where We Think They Do?

Ra'ed G Haddad, Adel Alrabadi, Motaz J Melhem, Mohamed A Saed, Mazen M Shaban, Muayyad Mujalli Murshidi, Mujalli Mhailan Murshidi


Background Aims: To test the old notion that stones get impacted in the ureter at one of three sites of narrowing: the pelviureteric junction, the middle ureter at the site where the ureter crosses anterior to iliac vessels, and the vesicoureteric junction.
Materials and Methods: A total of 149 patients who were admitted due to ureteral stones were retrospectively studied. Computerized tomography was used to measure stone size and delineate the exact anatomical location in the ureter.
Results: Stones were found to lodge most commonly (35.6%) at the area proximal to vesicoureteric junction but distal to the middle ureter, followed by the area between the pelviureteric junction and the middle ureter (26.2%). ‘Traditional’ sites of narrowing were the least common locations, as pelviureteric junction, mid ureter and vesicoureteric junction were the sites of impaction of 12.1%, 14.8% and 11.4% of ureteral stones, respectively. However, middle ureteral stones were relatively common in females unlike males. Also found, the smaller the stone size is, the more distal it will lodge. Body mass index was studied, and no significant association with location was found.
Conclusions: This study shows that the old notion of stones getting impacted at the three sites of narrowing in the ureter may not be accurate, as stones most commonly lodge not at these narrowing sites but between them.


Ureter; Ureteral Calculi; Ureteral Obstruction; Urolithiasis

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