Kidney Stone Stuck in the Ureter? Symptoms & Treatment | Dr. Theodore Cisu

The short answer: An obstructing ureteral stone is a kidney stone that has moved into the ureter, the narrow tube that carries urine from the kidney to the bladder, and is blocking urine from draining. Many small stones pass on their own with time and medication. Some need a procedure. A blocked kidney with a fever is an emergency.

Written by Theodore Cisu, MD, board-certified urologist. Based on the American Urological Association (AUA) guidelines on the surgical and medical management of kidney stones. Last reviewed November 2026.

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What is an obstructing ureteral stone?

Kidney stones form inside the kidney. Many sit there quietly for years. The trouble usually starts when a stone breaks loose and travels down the ureter toward the bladder.

The ureter is only a few millimeters wide, and it has three natural narrow spots where stones tend to get stuck:

1. Where the kidney drains into the ureter
2. Where the ureter crosses the blood vessels in the pelvis
3. Where the ureter enters the bladder

When a stone lodges in one of these spots, urine backs up behind it. The kidney's drainage system stretches, which doctors call hydronephrosis. That stretching is what causes the intense pain of a kidney stone attack.

Symptoms of a stone stuck in the ureter

• Severe pain in the side or back, below the ribs, often coming in waves
• Pain that moves toward the lower belly, groin, testicle or labia as the stone travels down
• Nausea and vomiting
• Blood in the urine, which may be pink, red or brown, or only seen under a microscope
• Urgency and frequent urination once the stone is close to the bladder
• Restlessness: many people can't find a comfortable position

When a kidney stone is an emergency

Go to the emergency room or call 911 if you have a known or suspected stone and any of the following:

• Fever or chills
• Pain you can't control with the medication you have
• Vomiting so much you can't keep fluids or medication down
• Very little or no urine
• Only one working kidney, a kidney transplant, or known kidney disease
• Pregnancy

Fever with a blocked kidney is the most important warning sign. Infected urine trapped behind a stone can lead to a serious bloodstream infection (sepsis). The AUA guideline calls for urgent drainage of the kidney in this situation, with either a ureteral stent or a nephrostomy tube, along with antibiotics. The stone itself is treated later, once the infection has cleared.

How an obstructing stone is diagnosed

• CT scan: A non-contrast CT scan is the most accurate test for finding a stone in the ureter and measuring its size and location. A low-dose CT is preferred when possible, to limit radiation.
• Ultrasound and X-ray: A kidney ultrasound together with an abdominal X-ray is a lower-radiation option, especially for follow-up of stones that show up on X-ray. Ultrasound is the first test during pregnancy.
• Urine and blood tests: A urine test looks for blood and signs of infection, and a blood test checks kidney function.

If you've already had a CT scan in the emergency room, you usually don't need another one before seeing a urologist. Dr. Cisu can review those images and reports with you, often by telehealth.

Treatment options

The right treatment depends on the stone's size and location, how much pain you're in, whether there's any sign of infection, your kidney function, and what matters most to you. Here is how the AUA guidelines approach it.

1. Giving the stone a chance to pass

For stones about 10 mm or smaller, with no infection and pain that's under control, waiting for the stone to pass is often a reasonable first step. Smaller stones are more likely to pass on their own than larger ones.

Medical expulsive therapy means taking an alpha-blocker such as tamsulosin, which relaxes the muscle of the lower ureter. The AUA strongly recommends offering it for stones of 10 mm or smaller in the lower ureter, typically for about 30 days. It may also be offered for stones higher up in the ureter, where the benefit is less certain.

During this time you'll usually:

• Take pain medication as prescribed
• Strain your urine to catch the stone so it can be analyzed
• Get follow-up imaging if you're not sure the stone has passed. Feeling better doesn't always mean the stone is gone: a stone can stop hurting while it still blocks the kidney.

2. Ureteroscopy

If the stone doesn't pass, keeps causing pain, or you'd rather not wait, ureteroscopy is the most common procedure. Under anesthesia, a thin scope is passed through the urethra and bladder into the ureter, with no incisions. The stone is broken up with a laser and the pieces are removed.

The AUA guideline notes that ureteroscopy has a higher stone-free rate than shock wave lithotripsy. A temporary ureteral stent may be placed afterward. For an uncomplicated procedure, a stent can often be skipped.

3. Shock wave lithotripsy (SWL)

SWL uses focused sound waves from outside the body to break the stone into small pieces that pass in the urine. It's non-invasive, but it's more likely than ureteroscopy to need a second treatment. Under the AUA guideline, either ureteroscopy or SWL may be offered for stones up to 10 mm in the lower ureter and up to 2 cm in the upper ureter. Dr. Cisu offers both ureteroscopy and shock wave lithotripsy at Augusta Health, and he can help you weigh the trade-offs.

4. Draining the kidney first

When there's infection, or the kidney needs relief before definitive treatment, a ureteral stent (a thin, soft tube inside the ureter) or a nephrostomy tube (a small drain through the back) lets urine flow around or past the stone. Stone treatment then follows once it's safe.

What about a ureteral stent?

A stent is a temporary tube that runs from the kidney to the bladder and keeps urine draining. It's completely internal. Many people notice bladder urgency, mild flank discomfort with urination, or some blood in the urine while it's in. These usually settle once it's removed, and medication can help in the meantime. Stents are removed in the office or, in some cases, with an attached string.

Kidney stones during pregnancy

During pregnancy, ultrasound is the first imaging test, and care is coordinated with your obstetrician. If symptoms are controlled, observation is usually tried first. If the stone doesn't pass, ureteroscopy, a stent or a nephrostomy tube are options.

After the stone: preventing the next one

Many people who have one kidney stone will form another. The AUA's 2026 guideline on the medical management of kidney stones focuses on prevention:

• Drink enough fluid to make about 2.5 liters of urine a day. Water is best, and it helps to limit soft drinks.
• Get the stone analyzed. Knowing what it's made of guides prevention.
• Consider metabolic testing. For people with repeat stones or higher risk, a 24-hour urine collection shows why stones are forming and leads to diet changes tailored to you.
• Medication when needed. Depending on your stone type and urine tests, medicines such as a thiazide, potassium citrate or allopurinol can lower the chance of new stones.

Don't cut out calcium-rich foods unless your doctor tells you to. For most people with calcium stones, a normal calcium intake is part of prevention.

Seeing Dr. Cisu for a kidney stone

Dr. Theodore Cisu treats kidney stones at his clinics in Charlottesville and Fishersville, with stone procedures performed at Augusta Health. If you've been to the emergency room, you can often start with a telehealth visit: our office gathers your CT scan and records, and Dr. Cisu reviews them with you and lays out your options. Second opinions are welcome, and no referral is needed. Book a visit.

Frequently asked questions

How long does it take to pass a kidney stone?

It varies. Some stones pass within days, others take several weeks. The AUA guideline typically pairs medical expulsive therapy with about 30 days of observation, followed by imaging to confirm whether the stone has passed. A stone shouldn't be left blocking a kidney indefinitely, even if the pain has eased.

Will a 5 mm stone pass on its own?

Stones of this size often pass, especially when they're in the lower ureter, but there's no guarantee. Location, the shape of your ureter and other factors matter. Your urologist can give you a sense of your own odds.

Does tamsulosin really help pass a stone?

Yes. Based on its review of the evidence, the AUA strongly recommends offering an alpha-blocker such as tamsulosin for stones of 10 mm or smaller in the lower ureter. Common side effects include dizziness when standing up and, in men, a temporary change in ejaculation.

Do I need the ER or can I see a urologist?

If you have fever or chills, uncontrolled pain or vomiting, very little urine, or a single kidney, go to the emergency room. Otherwise, a prompt visit with a urologist, including by telehealth, is often the right next step.

Can I work while waiting for a stone to pass?

Many people can, between pain episodes. It depends on your job and how well your pain is controlled. Avoid driving if your pain medication makes you drowsy.

Can a stuck stone damage my kidney?

A blockage that lasts too long can harm the kidney, which is why follow-up imaging matters even when symptoms improve. With timely care, most people keep normal kidney function.

Sources

• American Urological Association. Surgical Management of Kidney and Ureteral Stones: AUA Guideline (2026).
• American Urological Association. Medical Management of Kidney Stones: AUA Guideline (2026).

This article is for general education and isn't a substitute for medical advice. If you think you have an emergency, call 911 or go to the nearest emergency room.