title: The silence of the stones: asymptomatic ureteral calculi.
abstract: OBJECTIVE
  We investigated the characteristics and diagnosis of primary asymptomatic ureteral calculi.
  
  
  METHODS
  During a period of 12 years asymptomatic ureteral stones were prospectively investigated at the Urological Stone Center. We studied mode of diagnosis, stone size, localization, composition, hydronephrosis grade and patient characteristics.
  
  
  RESULTS
  Between 1995 and 2006 a total of 40 patients with asymptomatic ureteral stones were identified among 3,711 patients with ureteral stones (1.1%). Mean age of the 33 male and 7 female asymptomatic patients was 58.3 years (range 28.1 to 87.1). Localization of stones was 19 proximal, 3 mid and 18 in the distal ureter. Mean stone size was 10.0 mm (+/-6). Mode of diagnosis of asymptomatic calculi was randomly diagnosed hydronephrosis in 10 patients (25%), microscopic hematuria in 8 (20%), randomly diagnosed stone on other than urological x-ray examination in 13 (32.5%) and stone diagnosed during followup after previous nephrolithiasis in 9 patients (22.5%). Primary therapy was extracorporeal shock wave lithotripsy in 35 patients (87.5%), ureterorenoscopic lithotripsy in 4 (10%), spontaneous stone passage before scheduled treatment in 1 and open ureteroneocystostomy in 1 patient.
  
  
  CONCLUSIONS
  De novo asymptomatic ureteral calculi do exist. Characteristics of this small group of patients with ureterolithiasis have not been described thus far. Diagnosis is usually made during routine health care examinations, during the evaluation of nonurological diseases and during followup of patients who previously had nephrolithiasis. A large proportion of patients exhibit some degree of hydronephrosis as a sign of silent obstruction.
authors: Department of Urology, and Ludwig Boltzmann Institute of ESWL and Endourology, Rudolfstiftung Hospital Vienna, Vienna, Austria. florian.wimpissinger@gmx.at
authors: Florian
authors: F
authors: Wimpissinger
authors: Christian
authors: C
authors: Türk
authors: Oleg
authors: O
authors: Kheyfets
authors: Walter
authors: W
authors: Stackl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000175:diagnosis / Q000453:epidemiology; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D033162:Incidental Findings; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015607:Stents; D014057:Tomography, X-Ray Computed; D014514:Ureteral Calculi / Q000737:chemistry / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D018666:Ureteroscopy; D014519:Ureterostomy; D014567:Urography