VUJ Stone Explained: Symptoms, Passing Chances and Treatment

If your ultrasound or CT report says "VUJ calculus" or "calculus at the right VUJ", you are probably wondering two things: what does VUJ mean, and will this stone come out on its own?

Short answer: A VUJ stone is a kidney stone that has travelled all the way down the ureter and is stuck at the vesicoureteric junction (VUJ), the point where the ureter enters the bladder. It is the narrowest part of the ureter, so stones often get held up here. The good news is that a VUJ stone is in the best position to pass: in a CT-based study, about 79% of stones at this junction passed on their own. Small VUJ stones usually pass with fluids, pain relief and sometimes medicine. Larger stones, stones that do not move after a few weeks, or any stone with fever, uncontrolled pain or a blocked kidney need treatment, usually a quick ureteroscopy (URSL) without any cut.

This guide explains what a VUJ stone is, the symptoms it causes, how likely yours is to pass, and the treatment options if it does not.

What Is the VUJ?

The ureter is the tube that carries urine from each kidney to the bladder. It is narrowest at three points:

1. PUJ (pelviureteric junction): where it leaves the kidney
2. Where it crosses the blood vessels in the pelvis
3. VUJ (vesicoureteric junction): where it passes through the bladder wall

The VUJ is the narrowest of these. The ureter runs at an angle through the muscular bladder wall here, which acts like a valve. A stone that has made it all the way down often pauses at this final gate. That is why VUJ stones are so common, and also why they are often described as the "last stage" of passing a stone. Read what is the last stage of passing a kidney stone.

On reports, you may also see it written as UVJ (ureterovesical junction). It means the same thing.

Symptoms of a VUJ Stone

A stone at the VUJ often causes a different mix of symptoms from a stone higher up, because it is right next to the bladder.

Bladder-type symptoms (very common at the VUJ):

• A constant urge to pass urine, often passing only small amounts
• Going to the toilet very frequently, day and night
• Burning or discomfort while urinating
• A feeling that the bladder never fully empties

Pain:

• Pain in the lower abdomen or groin on one side
• Pain spreading to the tip of the penis, the testicle, or the labia in women
• Waves of side or back pain, especially if urine is backing up to the kidney

Other signs:

• Blood in the urine, visible or on a urine test
• Nausea or vomiting during pain episodes

Because these symptoms feel like a urine infection, many people take antibiotics for a "UTI" for days before a scan shows the stone. Read UTI vs kidney infection and kidney stone pain in stomach.

A useful clue: when the stone moves down from higher in the ureter to the VUJ, the side or back pain often eases and is replaced by urgency and frequency. Many patients take this as a sign the stone has passed, but it is often sitting at the bladder entry. Read signs that a kidney stone is about to pass.

How Likely Is a VUJ Stone to Pass?

Two things matter most: size and position. A widely cited study using CT scans of 172 patients with ureteral stones found these spontaneous passage rates:

In practical terms:

• VUJ stone up to about 5 mm: most pass on their own, usually within a few weeks.
• VUJ stone of 5 to 10 mm: a reasonable chance, especially with medicine that relaxes the ureter, but many need help, particularly towards 8 to 10 mm.
• VUJ stone over 10 mm: unlikely to pass; treatment is usually the better choice.

Other things that make passage less likely: a stone that has been stuck in one place for weeks, a stone that is irregular or very hard, a narrow ureter, and significant swelling around the stone. Read how long does it take to pass kidney stones, best treatment for 5mm kidney stones, best treatment for 7mm kidney stones and best treatment for 10mm kidney stones.

Treatment Option 1: Helping the Stone Pass (Medical Expulsive Therapy)

If the stone is small enough, there is no infection, the kidney is working well and pain is controlled, a trial of passing the stone is reasonable. This usually includes:

• Alpha blockers (such as tamsulosin): these relax the muscle of the lower ureter. The European Association of Urology (EAU) guideline recommends offering alpha blockers as one of the treatment options for distal ureteral stones of 5 to 10 mm.
• Pain relief, as prescribed. Anti-inflammatory painkillers are usually the first choice for stone pain if they are safe for you.
• Normal, steady fluids. Drinking several litres at once does not flush the stone and can increase pain if the ureter is blocked.
• Straining your urine to catch the stone so it can be analysed. Read kidney stones in the toilet: what to do after you pass one.
• A repeat scan after a few weeks to confirm the stone has gone, even if pain has settled.

A trial should have a time limit. A VUJ stone that has not moved after a few weeks, despite medicine, is unlikely to pass, and leaving it longer risks damage to the kidney. Read non-surgical treatment options for small kidney stones and how can I speed up the passing of kidney stones.

When a VUJ Stone Needs Urgent Care

Go to hospital the same day if you have a VUJ stone and:

• Fever, chills or shivering. A blocked, infected kidney needs urgent drainage with a stent or a nephrostomy tube and antibiotics; the stone is treated once the infection settles.
• Pain not controlled by medicine
• Persistent vomiting
• Very little or no urine
• Only one kidney, or stones blocking both sides
• Pregnancy

Read can a stone in the ureter damage the kidney and hydronephrosis causes and treatment.

Treatment Option 2: URSL (Ureteroscopic Lithotripsy)

For VUJ stones that do not pass or are too large, URSL is usually the treatment of choice. Because the VUJ is so close to the bladder, this is one of the quickest and most straightforward stone procedures.

• Under anaesthesia, a thin telescope is passed through the natural urinary passage into the bladder and up to the stone.
• The stone is broken with a laser and the pieces are removed or left as fine dust to pass.
• No cut, no stitches, no scar.
• Most patients go home the same day or the next morning.
• A temporary DJ stent may be placed for a short time if the ureter is swollen. After uncomplicated cases, a stent is not always needed. Read DJ stent explained.

Read more about URSL, URSL: a modern approach to kidney stone treatment and ureteroscopy for kidney stones.

Treatment Option 3: ESWL (Shock Wave Lithotripsy)

Shock waves can be used for some lower ureteric stones, but positioning can be harder because the pelvic bones are in the way, the fragments still have to pass, and more than one session may be needed. For VUJ stones, ureteroscopy usually clears the stone more reliably in a single sitting. ESWL is not used in pregnancy. Read about ESWL and how ureteral stones are treated.

Which Option Is Right for You?

After the Stone Is Out

Most people feel dramatically better once a VUJ stone passes or is removed. Mild burning or soreness for a day or two is common. Read can you still have pain after passing a kidney stone.

Then focus on prevention:

• Get the stone analysed to find out what it is made of. Read kidney stone analysis.
• Check whether other stones are still in the kidneys.
• Follow a prevention plan based on your stone type. Read how to avoid kidney stone recurrence.

Get Help Deciding

Whether to wait or treat a VUJ stone depends on its size, your symptoms and your life. Use our kidney stone checker to see what usually happens for stones like yours, explore kidney stone treatment options, or book a consultation with Dr. Deepanshu Gupta and bring your ultrasound or CT report.

Frequently Asked Questions

What does VUJ calculus mean?

It means a stone is stuck at the vesicoureteric junction, where the ureter enters the bladder. It is the narrowest point of the ureter and the most common place for a stone to get held up.

Can a VUJ stone pass on its own?

Often, yes. In one CT-based study, about 79% of stones at the VUJ passed on their own. Smaller stones pass more often; stones over 10 mm usually need treatment.

How long does a VUJ stone take to pass?

Many small VUJ stones pass within days to a few weeks. If a stone has not passed after a few weeks of medicine and monitoring, treatment is usually advised rather than waiting longer.

Why do I feel like urinating all the time with a VUJ stone?

The stone sits right at the bladder wall and irritates it, so the bladder feels full even when it is not. This urgency and frequency usually settles once the stone passes into the bladder or is removed.

Is a 6 mm VUJ stone likely to pass?

It has a reasonable chance, especially with an alpha blocker, but it is less certain than a stone under 5 mm. If it does not move within a few weeks, or causes repeated pain, URSL is usually recommended.

Does a VUJ stone need surgery?

Not always. Small stones without complications often pass with medicine. Larger stones, stones that do not move, or stones causing infection or blockage are usually removed with URSL, which needs no cut.

Can a VUJ stone cause a UTI?

A stone can cause symptoms that feel like a UTI, and it can also block urine and lead to a true infection. Fever or chills with a VUJ stone need urgent medical attention.

How do I know the VUJ stone has passed?

You may feel sudden relief from urgency and pain, and sometimes see or catch the stone in your urine. A repeat ultrasound or X-ray confirms it has gone, which matters because pain can settle even while a stone is still stuck.

References

1. Coll DM, Varanelli MJ, Smith RC. Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. American Journal of Roentgenology. 2002;178(1):101-103. https://read.qxmd.com/read/11756098
2. European Association of Urology. EAU Guidelines on Urolithiasis: Recommendations. https://uroweb.org/guidelines/urolithiasis/chapter/guidelines