Case Study: Understanding a Dilated Ureter and Non-Obstructive Kidney Stone

Kidney stones are a common urological condition, but not all stones cause blockage or pain. In this case, a patient underwent CT Urography for evaluation and was found to have a non-obstructive stone and a dilated ureter, pointing to a possible past event of stone passage or infection.

Let’s explore the case in detail.

Clinical Scenario

A male patient presented with discomfort in the abdomen. To assess the condition thoroughly, a CT Urography was performed, which provided detailed imaging of the kidneys, ureters, and bladder.

Key Findings from CT Urography

✅ Right Kidney:

• Size: 10.5 x 5.0 cm
• Normal structure and contrast function
• A 13 x 6.4 mm stone detected in the lower calyx
• No hydronephrosis (swelling of kidney) noted
• Ureter is dilated throughout, especially in the upper portion
• Ureter walls are hyper-enhancing (inflamed), with surrounding fat stranding
• No stone found in ureter, indicating possible recent passage of a stone

✅ Left Kidney:

• Size: 9.5 x 5.6 cm
• Malrotated (turned in a different direction), but otherwise healthy
• No stones, no swelling
• Ureter is normal and patent

✅ Other Findings:

• Urinary bladder: Partially filled, no abnormalities
• Prostate: Normal
• No signs of tumors or fluid in the abdomen
• Small lymph nodes in the mesentery, likely non-significant

Interpretation & Clinical Insight

🔹 What Does This Mean?

• The right kidney stone is non-obstructive, meaning it’s not blocking urine flow.
• The right ureter is dilated, which might indicate:
  • A recently passed stone that caused temporary irritation
  • Ureteritis (inflammation of the ureter), possibly due to infection or trauma from the stone
• The inflammation (hyper-enhancement) and subtle fat stranding around the ureter support these possibilities.

Next Steps: Treatment & Advice

This patient does not currently require emergency surgery, but monitoring and medical treatment are essential:

Suggested Next Steps:

1. Urine tests to rule out infection (especially if there are white cells or bacteria)
2. Blood work to assess kidney function (e.g., creatinine, BUN)
3. Follow-up imaging to ensure the ureter returns to normal diameter
4. Urological consultation to decide whether the non-obstructive stone needs preventive treatment (like dietary changes, hydration, or medication)
5. Pain management and possible antibiotics if ureteritis is confirmed

Why Follow-Up is Important

Even if the stone is not causing a blockage right now, it can:

• Grow larger
• Move into the ureter
• Cause pain, infection, or obstruction in the future

A dilated ureter is not normal and must be taken seriously to avoid long-term complications like:

• Ureteral strictures (narrowing)
• Recurrent infections
• Kidney function decline

Conclusion

This case shows how advanced imaging like CT Urography plays a crucial role in diagnosing hidden problems like inflammation or recently passed stones—even when the current stone isn’t causing major symptoms.

By identifying early signs of possible complications, clinicians can treat patients proactively and prevent further damage.