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A ureteric stone is a kidney stone that has dropped out of the kidney and become stuck in the ureter, the narrow muscular tube that carries urine down to the bladder. When a stone gets wedged there, urine backs up, the ureter goes into spasm, and the result is the sudden, gripping flank pain that sends many men straight to an emergency room. It is one of the more intense pains in clinical medicine, and it tends to arrive without warning.
This guide is written for men trying to make sense of that pain and the decisions that follow: what is actually happening, which stones can be left to pass on their own, when a procedure is needed, what those procedures involve, and what they cost in Bangkok in both Thai baht and US dollars. Ureteric stones are common, they skew male, and they are highly treatable, but the right path depends on the stone's size and position, your symptoms, and whether there is any sign of infection or blockage. None of that can be settled without a scan and a clinician, so treat the numbers and timelines below as a map rather than a prescription.
What a ureteric stone is, and why men get them more often
Stones form in the kidney when urine becomes concentrated and certain minerals, most commonly calcium oxalate, crystallise and clump together. A stone may sit silently in the kidney for years. Trouble usually starts when it breaks free and travels into the ureter. Because the ureter is only a few millimetres wide and narrows further at three natural points, even a small stone can lodge and obstruct the flow of urine.
Where the stone sits matters. Urologists describe stones as upper (proximal), mid, or lower (distal) ureteric, and the location influences both how likely the stone is to pass and which treatment works best. A stone sitting low, near the bladder, behaves differently from one stuck high near the kidney.
Men are affected more often than women. A widely cited review in *Investigative and Clinical Urology* reported a US lifetime prevalence of around 10.6% in men versus 7.1% in women, with a male-to-female ratio that has historically run as high as 3:1, though that gap has been narrowing over recent decades (Ziemba & Matlaga, 2017). The reasons are partly hormonal and partly behavioural. Higher muscle mass and dietary patterns common in men, more animal protein, more salt, and chronic under-hydration, all push urine chemistry toward stone formation. Men in hot climates who sweat heavily and drink too little, a familiar pattern for expats and travellers in Thailand, concentrate their urine and raise their risk further.
Stones also recur. After a first stone, the same review put the risk of a second event at roughly 11% at 2 years, 20% at 5 years, and around 39% at 15 years (Ziemba & Matlaga, 2017). That is why dealing with the stone in front of you is only half the job; the other half is changing the conditions that produced it.
Symptoms: what a ureteric stone actually feels like
The hallmark is renal colic: severe pain that comes in waves, starting in the flank or side and often radiating around to the groin or, in men, down toward the testicle. The waves reflect the ureter contracting against the obstruction. Between waves there may be a dull ache rather than full relief.
Other common features include:
Nausea and vomiting, sometimes severe enough to be the main complaint
Blood in the urine, which can look pink, red, or tea-brown, or may only show up on a urine test
A frequent, urgent need to urinate, especially as the stone nears the bladder
Pain or burning when passing urine
Restlessness and an inability to find a comfortable position, which is fairly characteristic, people with colic tend to pace rather than lie still
Two symptoms change the situation from urgent to emergency. Fever or chills alongside stone pain may signal an infected, obstructed kidney, which can become life-threatening quickly. Inability to pass any urine, particularly with only one functioning kidney or with stones on both sides, is also an emergency. Either should prompt immediate medical care rather than waiting to see whether the stone passes. More on red flags below.
How ureteric stones are diagnosed
Getting the diagnosis right drives every decision that follows, because treatment is chosen on the stone's exact size, density, and position.
Non-contrast CT (CT KUB). This is the reference standard. A low-dose CT of the kidneys, ureters, and bladder shows the stone's size to the millimetre, its location, its density (which hints at how it will respond to shockwaves), and the degree of obstruction behind it. It takes minutes and needs no contrast dye.
Ultrasound. Useful as a first look, especially in younger men, to limit radiation, and in situations where CT is not immediately available. It readily shows swelling of the kidney (hydronephrosis) from a blockage but can miss smaller stones or those sitting mid-ureter.
Urinalysis. Checks for blood and, importantly, for signs of infection. White cells or nitrites in the urine alongside an obstructing stone raise the stakes considerably.
Blood tests. Assess kidney function, white cell count, and electrolytes, and help flag patients who need urgent intervention.
A urologist combines these results to decide whether your stone can be watched or needs active removal. The same scan also guides the choice between shockwave lithotripsy and ureteroscopy if a procedure is required.
Treatment options, from watchful waiting to surgery
There is a genuine menu here, and more intervention is not always better. The aim is to clear the stone with the least invasive approach that will actually work for its size and position.
Conservative management and medical expulsive therapy (MET)
Many ureteric stones can be left to pass on their own. The likelihood depends heavily on size. The European Association of Urology notes that roughly 75% of stones under 5 mm and about 62% of stones 5 mm or larger pass spontaneously, with stones under 5 mm in the lower ureter passing nearly 90% of the time and an average passage time around 17 days (EAU Guidelines on Urolithiasis).
Conservative management combines generous fluid intake, anti-inflammatory or other pain relief, and watchful waiting with a plan to re-scan if the stone does not pass. For some stones, a doctor may add an alpha-blocker such as tamsulosin to relax the lower ureter and help the stone along. The evidence here is nuanced: guidelines and reviews suggest the clearest benefit is for distal ureteric stones in roughly the 5-10 mm range, with little added benefit below 5 mm (EAU Guidelines on Urolithiasis). One review of medical expulsive therapy reported tamsulosin expulsion rates around 77% versus 50% with no drug in suitable patients, with transient low blood pressure the main side effect (Bos & Kapoor, 2014). The American Urological Association recommends offering alpha-blockers for about 30 days for ureteric stones up to 10 mm when observation is appropriate (AUA Guideline). MET is a prescription decision, and treatment should stop if infection, uncontrolled pain, or worsening kidney function develops.
Shockwave lithotripsy (ESWL)
ESWL uses focused acoustic shockwaves delivered from outside the body to break the stone into fragments small enough to pass in the urine. There is no incision and usually no general anaesthetic, though sedation is common. It tends to suit stones smaller than about 1 cm, and stones in the upper ureter or kidney often respond better than lower ones. Results vary with stone density and body habitus, and some men need a second session. Recovery is quick, often the same day, with some blood in the urine and mild ache as fragments pass over the following days.
Ureteroscopy with laser lithotripsy (URS)
In ureteroscopy, a very thin scope is passed up through the urethra and bladder into the ureter, the stone is located directly, and a laser fibre fragments or dusts it. Fragments can be removed with a tiny basket. It is performed under anaesthetic as a day case or with a short stay. URS suits larger stones, lower ureteric stones, stones that have failed to pass with MET, and situations where rapid, reliable clearance is needed.
Its main advantage is a higher chance of being stone-free after a single procedure. The EAU notes that URS achieves higher early stone-free rates than ESWL with fewer retreatments, at the cost of a slightly higher complication rate and the frequent need for a temporary stent (EAU Guidelines on Urolithiasis). The AUA lists URS and ESWL as reasonable options for most ureteric stones, reserving a percutaneous approach for very large or treatment-resistant stones (AUA Guideline).
A ureteral stent, a soft hollow tube that keeps the ureter open, is often placed after ureteroscopy to let swelling settle and is removed days to a few weeks later. It is not always required after a straightforward procedure, but it is common, and it can cause its own bladder discomfort while in place.
Emergency drainage
When an obstructing stone is combined with signs of infection (fever, a high white cell count, sepsis) or with failing kidney function, the priority shifts. Before any attempt to remove the stone, the blocked system must be drained urgently, either by placing a stent or by inserting a nephrostomy tube through the back directly into the kidney. The AUA is explicit that obstructing stones with suspected infection need urgent drainage (AUA Guideline). This step can be lifesaving, and definitive stone removal is deferred until the infection is controlled.
Comparing the main options
The table below summarises how the common approaches differ. It is a starting point for the conversation with your urologist, not a substitute for the scan-based recommendation you will receive.
Approach | Best suited to | Anaesthetic | Single-session clearance | Typical downtime | Notes |
Conservative / MET | Stones under ~5-6 mm, mild symptoms | None | n/a (passes naturally) | Days to ~2-3 weeks | Add tamsulosin mainly for 5-10 mm distal stones |
ESWL (shockwave) | Stones under ~1 cm, upper ureter/kidney | Sedation, usually no GA | Often, may need a repeat | Same day to a few days | No incision; fragments pass over days |
Ureteroscopy + laser | Larger or lower stones, failed MET | General or spinal | High, usually one session | A few days; longer if stent placed | Best stone-free rate; stent often needed |
Emergency drainage | Infected or obstructing stone | Sedation/GA | Not definitive (drains first) | Until infection clears | Stent or nephrostomy; stone removed later |
Who is and is not a candidate
Good candidates for active stone removal include men with stones unlikely to pass (larger or stuck high), pain that analgesia cannot control, a stone that has failed a reasonable trial of conservative management, or any sign of obstruction threatening kidney function. The EAU lists low likelihood of passage, persistent pain, persistent obstruction, and renal impairment among the indications for intervention (EAU Guidelines on Urolithiasis).
The procedure choice, rather than whether to treat, is where most contraindications sit. ESWL is generally avoided in pregnancy, in untreated urinary infection, in uncorrected bleeding disorders, and in some anatomical situations; very dense or very large stones may resist it. Ureteroscopy may be harder where anatomy is unusual or where there is active, untreated infection, which must be cleared first. Any general anaesthetic carries the usual considerations around heart and lung health. Men on blood thinners, with a single kidney, with poorly controlled diabetes, or with significant other illness need an individualised plan. This is exactly the kind of judgement that requires a medical consultation, appropriate imaging, and a prescription; self-treating a suspected stone, beyond drinking water while you arrange care, is not safe.
What it costs in Bangkok (THB and USD)
Bangkok is a well-established destination for stone treatment, with experienced urologists, modern laser and shockwave equipment, and prices that are often a fraction of those in the US, UK, or Australia. The figures below are indicative ranges for private hospitals and clinics in Bangkok and should be confirmed at consultation, since the final bill depends on your specific case. They are drawn from published Bangkok hospital and medical-travel pricing current in 2026; the wide bands reflect real differences between standard and premium international hospitals.
Item | Indicative Bangkok price (THB) | Approx. USD | Typical US/UK range (USD) |
Non-contrast CT (CT KUB) | 6,000-15,000 | 175-435 | 1,000-3,000 |
Consultation + urinalysis/bloods | 2,000-6,000 | 60-175 | 200-600 |
Medical expulsive therapy (meds) | 1,500-5,000 | 45-145 | 100-400 |
ESWL (shockwave lithotripsy) | 35,000-90,000 | 1,000-2,600 | 5,000-12,000 |
Ureteroscopy + laser (URS) | 90,000-200,000 | 2,600-5,800 | 9,000-20,000+ |
Ureteral stent (placement) | 30,000-80,000 | 870-2,300 | 2,000-6,000 |
A few honest caveats. International medical-travel aggregators sometimes quote ESWL in Bangkok as high as USD 4,500-6,000; those figures tend to reflect premium-hospital, all-inclusive tourist packages rather than the more typical Thai private-hospital pricing reflected above. Laser ureteroscopy packages have been quoted around THB 100,000-200,000 by Bangkok providers. Always ask for a written quotation specific to your scan.
What actually drives the cost
Procedure type. Laser ureteroscopy, an operating-theatre procedure under anaesthetic, costs more than ESWL, which in turn costs more than tablets and fluids.
Stone size, number, and position. Bigger, harder, or multiple stones take longer and may need staged treatment or a second session.
Hospital tier. A JCI-accredited international hospital prices above a mid-tier private hospital for the same procedure.
Anaesthesia and stay. General anaesthetic, an overnight bed, and surgeon seniority all add to the total.
Stent and follow-up. A stent placement, then a second short visit to remove it, is a common add-on after ureteroscopy.
Imaging and labs. The CT, urine, and blood work are usually billed separately from the procedure itself.
When you compare quotes, check what is and is not included: anaesthesia, the surgeon's fee, the stent, pre-operative tests, and the follow-up scan are the items most often left out of a headline price.
Recovery, step by step
Recovery depends entirely on which route you take.
After passing a stone naturally or with MET. Expect intermittent colic until the stone passes, then rapid relief. Strain your urine if asked, so the stone can be analysed, since knowing its composition guides prevention. Most men are back to normal within days of passage, though the waiting period can stretch to a couple of weeks.
After ESWL. Often a same-day discharge. Pink urine and mild flank ache are normal for a few days as fragments clear. Drink plenty of fluids to flush them. Most men resume light activity within a day or two and full activity within a few days.
After ureteroscopy with laser. Plan for a day case or one night in hospital. The first 24-48 hours may bring some burning on urination and pink urine. If a stent is in place, expect bladder urgency, a feeling of incomplete emptying, and occasional flank twinges when you urinate; this is the stent, not a complication, and it eases once it is removed. Many men return to desk work within a few days and to exercise within roughly one to two weeks. Bangkok hospitals generally advise resuming normal activity around a week after laser lithotripsy (Vejthani Hospital).
Stent removal. Usually a quick clinic procedure under local conditions, performed days to a few weeks after the main treatment. Comfort improves noticeably once it is out.
If you are travelling to Bangkok specifically for treatment, build in time for follow-up. A week on the ground is a reasonable minimum for a procedure plus a check before flying, and longer if a staged treatment or stent removal is planned.
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Results you can reasonably expect
Stone treatment is, on the whole, very successful. The realistic goals are complete clearance of the stone, relief of the obstruction, return of normal urination, and protection of kidney function. Ureteroscopy in particular offers a high chance of being stone-free after a single procedure, while ESWL may occasionally need a repeat session to finish the job (EAU Guidelines on Urolithiasis). Most ureteric stones are fully treatable with these minimally invasive methods, and serious complications are uncommon in experienced hands.
The honest counterpoint is recurrence. Clearing today's stone does nothing to change the chemistry that made it, and a substantial share of men form another stone within a few years (Ziemba & Matlaga, 2017). Hydration aimed at pale urine, moderating salt and animal protein, and, where indicated, a metabolic work-up after a recurrent or unusual stone are the levers that actually lower future risk.
Risks and side effects
Most men recover without incident, but no procedure is risk-free, and a few warning signs should never be ignored.
Common and usually self-limiting:
Blood in the urine for a few days
Mild flank or bladder discomfort, especially with a stent in place
Burning on urination after ureteroscopy
Aching as ESWL fragments pass
Less common:
Urinary tract infection, which may need antibiotics
Stone fragments that fail to clear and require a further session
Narrowing or, rarely, injury to the ureter during ureteroscopy
Bruising over the treated area after ESWL
Red flags, seek urgent care:
Fever above roughly 38°C or shaking chills, a possible infected, obstructed kidney
Inability to pass any urine
Pain that is severe and not controlled despite medication
Heavy bleeding or large clots in the urine
Persistent vomiting that prevents you keeping fluids down
A fever with a known or suspected stone is the one that matters most. An infected, blocked kidney can deteriorate into sepsis within hours and needs emergency drainage rather than watchful waiting (AUA Guideline).
Choosing a clinic safely in Bangkok
Bangkok offers excellent stone care, but quality varies, and a few checks separate a reassuring clinic from a risky one.
What to look for:
A urologist who treats stones regularly and can quote their own approach and outcomes
On-site or rapid access to non-contrast CT, so treatment is planned on a proper scan rather than a guess
Modern laser and shockwave equipment, and a clear answer on which they would use for your stone and why
A written, itemised quotation that spells out what the price includes
A sensible follow-up plan, including stent removal and a check scan
Clear English-language communication and an accessible booking channel
Red flags worth heeding: a quote for a procedure before anyone has scanned you, pressure to choose the most expensive option without a clinical reason, no named surgeon, vague or shifting pricing, or a reluctance to discuss complications and what happens if the first treatment does not fully clear the stone. A clinician who is comfortable saying your small stone can simply be watched is often a more trustworthy sign than one who recommends surgery for everything.
Why men choose Bangkok for stone treatment
Several things draw men to Bangkok for ureteric stones specifically: fast access to CT imaging and to a urologist, often within the same day; experienced stone specialists and up-to-date laser and shockwave equipment; prices well below Western hospitals for the same procedure; short downtime that fits around a trip; and discreet, private care, which matters to men who would rather keep a urological problem to themselves. For expats already living in Thailand, having an English-speaking men's-health service that handles the whole pathway, scan, decision, procedure, and follow-up, removes a lot of friction at a genuinely painful moment.
Talk to a urologist
If you are dealing with flank pain, blood in the urine, or a stone already found on a scan, the sensible next step is a consultation with a urologist who can review your imaging and lay out your options clearly. Remember that any treatment, from a tamsulosin prescription to laser surgery, requires a medical consultation, appropriate imaging, and a prescription. If you have fever, cannot pass urine, or have pain that will not settle, treat it as an emergency and seek care now rather than booking ahead.
Book a private consultation with Menscape Bangkok to have your symptoms or scan reviewed and to get a clear, itemised plan and quotation for your specific stone.
Frequently Asked Questions
Can a ureteric stone pass on its own?
Often, yes, especially smaller ones. Guidelines report that around 75% of stones under 5 mm pass spontaneously, and stones under 5 mm sitting low in the ureter pass nearly 90% of the time, on average within a couple of weeks. The larger the stone and the higher it sits, the lower the chance, which is why a scan matters before deciding to wait.
How big is too big to pass naturally?
There is no hard cut-off, but the odds drop sharply above about 5-6 mm, and stones larger than around 7 mm frequently need a procedure. A urologist weighs size together with location, your symptoms, and any obstruction rather than going on size alone.
Does tamsulosin really help a stone pass?
It can, for the right stone. Alpha-blockers like tamsulosin relax the lower ureter, and the clearest benefit is for distal stones in the 5-10 mm range; below 5 mm the added benefit is small. It is a prescription decision, and it should be stopped if infection, uncontrolled pain, or worsening kidney function develops.
Is laser ureteroscopy safe?
In experienced hands it is both safe and highly effective, and it offers the best chance of being stone-free after a single procedure. Like any procedure it carries some risk, mainly temporary blood in the urine, bladder discomfort from a stent, and occasionally infection or, rarely, ureteric injury. Serious complications are uncommon.
What does ureteric stone treatment cost in Bangkok?
Indicative private-hospital ranges are roughly THB 35,000-90,000 (about USD 1,000-2,600) for ESWL and roughly THB 90,000-200,000 (about USD 2,600-5,800) for laser ureteroscopy, with a stent adding around THB 30,000-80,000 if needed. These are starting points, not quotes; the final price depends on your scan, the hospital tier, and what the package includes, so confirm at consultation.
When is a ureteric stone an emergency?
Fever or chills with stone pain may mean an infected, blocked kidney, which can become dangerous within hours and needs urgent drainage. Being unable to pass any urine, pain that will not settle despite medication, or heavy bleeding are also emergencies. In any of these situations, seek immediate care rather than waiting for the stone to pass.
Will I need a stent, and what is it like?
A stent is a soft tube that holds the ureter open while swelling settles, and it is commonly placed after laser ureteroscopy, though not always required after a straightforward case. While it is in, expect some bladder urgency and a feeling of incomplete emptying, plus occasional flank twinges when you urinate. It is removed in a quick clinic visit days to a few weeks later, and the discomfort eases once it is out.
Do ureteric stones come back?
Recurrence is common. After a first stone the risk of another is roughly 1 in 5 within 5 years and close to 2 in 5 within 15 years. Clearing the stone does not change the chemistry that caused it, so staying well hydrated, moderating salt and animal protein, and, after a recurrent or unusual stone, having a metabolic work-up are what actually lower future risk.
How long should I stay in Bangkok if I travel for treatment?
Plan for at least about a week. That allows for the scan, the procedure, recovery, and a follow-up check before flying, and longer if a staged treatment or stent removal is scheduled. Build in buffer time rather than booking a tight return.
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