Health emergencies—including personal painful conditions, pandemics, natural disasters, and conflict-driven crises severely threaten social commitment by eroding overwhelming health systems approaches and deepening socio-economic inequalities. These events, which have increased over threefold since 1980, disrupt the social fabric and disproportionately affect vulnerable populations & their smaller functions like children’s naming or Upanayana Ceremonies.  Keyways health emergencies that threaten social commitment include: i) Health facilities and /or doctors get overwhelmed & preferring surgical interventions instead of a minimum invasive approach that allow recovery in 2-3 days, even if it is temporary, just for the emergency itself and planning for long-term solutions. ii) Pandemics and crises cause fear and anxiety, which can lead to family separation, & social unrest iii) Long-term, psychological trauma from emergencies like Angina, IHD, Abdominal Colic, anxiety, grief, Post-Traumatic Stress Disorder (PTSD). PTSD is a psychiatric condition that develops after experiencing or witnessing traumatic events, such as accidents, death of a parent, sexual abuse of a daughter etc.  iv) Erosion of trust in authorities and public institutions, especially if responses are viewed as inequitable.  If the health care providers can consider, such small but important commitment and provide a minimum invasive approach where recovery occurs in 2-3 days, even if it is temporary, and planning for long-term solutions will be yeomen service 

Materials & Methods: This observational study gives an account of handling a ureteric colic case of a young professional in his forties, to celebrate a well-planned and widely intimated Upanayana Ceremony of his lone son just 5 days before the event scheduled for 4 May 2026.  He was subjected to a minimum invasive Process of the Stone Relocation (Push-Back). Pushing a kidney stone back from the ureter into the kidney is a urological procedure designed to provide immediate relief from pain and obstruction. By moving the stone into the kidney (the renal pelvis), the blockage in the narrow ureter is removed, allowing urine to flow freely and reducing the severe colic pain associated with ureteral obstruction. 

Outcome: The intervention relieved the pain in 48 hours, and the individual was able to fulfil the social obligation of celebrating Upanayana under medical supervision and is scheduled to undergo Lithotripsy next week for a permanent solution.

The diverse manifestations of urolithiasis provide very interesting data. The etiopathogenesis of renal stones, which is believed to be multifactorial, both exogenous and endogenous. VDR Fok1 is a risk factor for renal stone formation and could cause formation of renal stones through the mechanism of crystal induction and crystallization in the urine. While a few recent studies have shown the role of heavy metals like cadmium and lead in the formation of renal stones, the current knowledge is still insufficient [1].

Nearly 12% of the population is prone to urinary stones in India, of which Ureteral calculi contribute to 37% of stone cases. Approximately two million persons are affected by urolithiasis annually in India. The disease is more prevalent in the "stone belt" region of India, which includes Gujarat, Rajasthan, Maharashtra, Delhi, Punjab, Haryana, and the Northeast. Ureteral stones are often found in the lower 1/3rd of the ureter. While it affects all ages, it is most common in individuals aged 30–50. Some studies show a higher prevalence in males, though others suggest a rising incidence in females. Indian data indicates a dramatic rise in incidence from less than 40/Lakh inhabitants in the 1960s to 1200/per lakh population in 2025 inhabitants.  Approximately 50% of patients experience a recurrence within 5 years [2].

High intake of oxalate-rich foods (tomatoes, spinach, cashew nuts) and purine-rich foods (red meat, seafood), hot climates leading to dehydration, combined with sedentary jobs and increasing obesity rates are the risk factors.  Pushing a kidney stone back from the ureter into the kidney is a urological procedure designed to provide immediate relief from pain and obstruction. By moving the stone into the kidney (the renal pelvis), the blockage in the narrow ureter is removed, allowing urine to flow freely and reducing the severe colic pain associated with ureteral obstruction. The Process of Stone Relocation (Push-Back), is a procedure done by a urologist in a hospital setting under general or regional anaesthesia. As the procedure can cause swelling, a temporary stent is often placed in the ureter to keep it open & and ensure continued urine drainage. Alternately in some cases, retrograde injection of 2% lidocaine jelly through a catheter placed below the stone can help it glide back into the renal pelvis [ 4,5].

The main goal is to stop the severe pain caused by a stone obstructing the ureter. Apart from giving immediate relief, it facilitates future treatment, as a stone inside the kidney is easier to treat using less invasive methods, like Shock Wave Lithotripsy (SWL), than one that is deeply lodged in the lower ureter. It alleviates pressure on the kidney, reducing the risk of infection and kidney damage [4].  This article is based on a case report of a male aged around 40 years, an electrical engineer who had severe Ureteric calculus pain just a week before his sons’ Upanayana ceremony on 4th May 2026. An Ureteroscopy relieved his pain in 48 hours and was able to participate in the ceremony.

Mr Anand an electrical engineer working with Karnataka State Electricity Board (KEB), in his early 40’s, prepared from March 2026 for the Upanayana ceremony of his only 13-year-old son. Both husband and wife a lecturer in a local college, made elaborate preparation and had invited about 300 people for the function scheduled on 4 May 2026, hiring a private convention hall in one of high-end locality of Bengaluru city. In the run up to the function while the couple worked hard and most of the outside running around work was done by Mr. Anand. Bengaluru had faced worst summer for so far in its history in April 2026. Dehydration was common for many working in sunny days. On 29 April 2026 around late evening Mr. Anant started getting severe abdominal pain. Severe pain in his back under the lower ribs radiated his lower abdomen. He had severe pain while peeing. Within about 4 hrs of the beginning, he had Nausea and vomiting. Frequent urges to pee and only a small amount of pee each time bothered him and entire family was in panicky due the upcoming function. The immediately consulted a private tertiary care hospital around 1000 PM.

The hospital gave him analgesic injection and IV fluids for the night and did a CT scan. A calculus of about 6 mm diameter was in Right Ureter. An initial advice of Lithotripsy was suggested, that would immobilize him for 5-7 days. After explaining the urgency in view of the Upanayana function, Urologist offered a minimum invasive Process of Stone Relocation (Push-Back), a procedure done under general or anaesthesia, and a stent to keep the ureter open & and ensure continued urine drainage, to be followed by Lithotripsy and kidney stone removal a few weeks later.

On 30th April morning Urologist surgeon inserted a small, flexible camera (ureteroscope) through his urethral opening in Penis, under general anaesthesia and reached the location of the stone in the upper third portion of the right Ureter. The procedure lasted for about an hour. As the stone is large, and close to kidney it was pushed back into the Pelvis of the Right Kidney. The passage of the ureteroscope resulted in swelling in the ureter, therefore, the surgeon put a stent & left a ureteral stent, for 4–7 days to reduce swelling and aid the kidneys drain urine well. The patient was made to an overnight hospital stay. By the end of the day on 30 April, he was on way to recovery, with no pain and returned home the next day. He resumed his normal activity from 2 May 2026 and was able to take active role in his Son’s Upanayana on 4 May 2026 with IV canula in his hand.  While rare, potential complications reported in literature include pain, bleeding, infection, and damage to the ureter, so far Anand is doing well. He is scheduled to go for Lithotripsy next week.

Discussions: 

A ureteral stone is a kidney stone that’s stuck in one of the ureters, the muscle tubes that connect kidneys to urinary bladder. Ureters are 10 to 12 inches long, depending on individual’s height. Most of us have one ureter for each kidney. A ureteral stone or calculus is an irregularly shaped solid mass of crystals, minerals and salts that build up in the pee. Some stones can block the flow of pee and cause severe pain. Urinary stones are common. They affect about 1 in 10 people in the world. Stones may show up near the end of the ureter that connects to the renal pelvis, in the centre of each of the kidneys, it collects pee. Stones may also be in the middle or end of the ureter that connects to the bladder.

Ureteral stones can vary in size. When they’re tiny, they pass through our pee and don’t cause any problems. The larger the stones, the lower the chance of them passing on their own, and the greater the chance individual will have symptoms. There are 4 types of ureteral stones which include: 

• Calcium stones: These are the most common 2 type of ureteral calculus namely a) Calcium oxalate stones and b) Calcium phosphate stones.                       
• .Uric acid stones: Uric acid stones form when there’s too much uric acid in our pee.           
• Struvite stones: Struvite stones form after an individual had a urinary tract infection (UTI). Magnesium ammonium phosphate (struvite) & Calcium carbon-apatite make most of them. 
• Cystine stones: The genetic disorder cystinuria causes cystine stones. Cystinuria makes the amino acid cystine leak out of our kidneys and into our pee.

A case-control prospective study in Guru Teg Bahadur (GTB) Hospital, a tertiary care facility in Delhi with 30 cases and 30 controls, between November 2011 and April 2013. Patients defined as cases with renal stones diagnosed based on history & radiological investigations. Controls were selected from the patients admitted to the department of surgery for reasons other than renal stones. Metal levels analysed by atomic absorption spectrophotometer at Delhi University. The vitamin D receptor gene was measured using genomic DNA. Horizontal agarose gel electrophoresis was used for the quantification of the genomic DNA. The results indicated that nearly 83% of cases had the ff allele of the Vitamin D receptor gene compared to 46% of controls. The median arsenic and lead levels were higher among cases compared to controls. In the unadjusted model of logistic regression, found stressed patients had three times higher odds of developing renal stones compared to non-stressed patients. Similarly, patients with higher blood concentrations of arsenic and lead had higher odds of developing renal stones compared to those with lower concentrations. The study inferred that there was a definitive role of heavy metals, including lead, cadmium, and arsenic, seen with renal stones. A significant association was seen between the ff allele of VDR polymorphism (Fok1 enzymes) and patients with renal stones. Other parameters, including male and stress factors, seem to have an important role in renal stone formation [2].

Another single-centered prospective study comprised 300 patients with nephrolithiasis (age, 18–90 years) admitted to the Caritas Hospital in India between October 2022 and March 2023 with a control group to determine the significance of dietary and lifestyle risk factors in nephrolithiasis. Patient demographics, clinical data, and therapeutic data were collected from the patients and their medical records. The results indicated that most of the patients (76%) were males (median age, 52.44 ± 14.33 years), and the risk of recurrence was 60%–90%. Alcohol consumption & obesity were significantly correlated with nephrolithiasis in the kidney stone groups compared with the control group (P < 0>

Symptoms of a ureteral stone: Tiny ureteral calculi pass through our urinary system on their own without any symptoms. But stones that block our ureters or any of our kidneys’ cause Symptoms like i) Severe pain that comes & goes in the individual’s back or side (under the lower ribs) ii) Pain that radiates to your lower abdomen iii) Pain or a burning feeling while peeing iv) Nausea and vomiting v) Bloody or brown/ pink /or red urine vi) Cloudy pee         vii) Frequent urges to pee and only a small amount of pee when each time you go viii) Patient may have a fever, chills or an unwell feeling when you have a urinary tract infection along with the passage of stones.

Ureteral stone causes: Stones form when there’s too much of a stone-forming substance (crystals) in a small amount of the pee. If one drinks enough water, the substances that make up ureteral stones usually become diluted and less likely to make stones. Though, anyone can develop a ureteral stone, males (but females and children get them, too), those aged between 40 and 60 yrs, and have a biological family history of stones, in hot summer which leads to dehydration, individuals who do not periodically replace fluids and thus do not make a good amount of pee. Urine formation depends upon how much water one drinks and how much water you lose through sweat and medical issues, those who have Type 2 diabetes, high BMI (body mass index) above 30 and any medical conditions that cause diarrhoea, like Crohn’s disease or ulcerative colitis and polycystic kidney disease

Lowering Individual Risk: Each one of us will be able to lower the risk of kidney stones by   a) make sure of drinking enough water especially in summer to the extent that our pee must  look colourless or pale yellow b) Minimize eating  items of oxalate-rich foods- tomatoes, spinach, cashew nuts and purine-rich foods -red meat, seafood which contribute to kidney stones formation c) Periodically get a series of tests called a metabolic workup for kidney stones to guide on improved stone prevention

Complications of this condition: If timely treatment for ureteral stones is not sought, untreated stones grow larger, block the passage of pee through the ureter and cause pain. It increases the risk of an infection. The worst is a blockage can make your kidney swell from the backup of pee and damage the kidneys.

Diagnosis: A ureteral stone is diagnosed based on the symptoms, previous history of kidney stones and other medical issues. Physical examination to elicit tenderness. Final diagnosis is made on tests to confirm ureterolithiasis. Tests to diagnose ureteral stones include:

1.Urinalysis: Urine test looks for signs of infection and measure the number of substances in the pee that cause ureteral stones. If an infection is suspected they can order a urine culture.

2. Blood test: Called as Kidney Function Tests (KFT) reveal how well kidneys are working, check for infection and look for other problems that may cause ureteral stones.

3. Ultrasound: This uses sound waves to look for blockages in your ureters.

4. X-ray of Pelvis and Abdomen: This helps to show a stone is in the kidneys or ureters.

5.Computed tomography (CT) scan: A CT scan locates the stone, its size, & hardness which   provides information to help plan treatment.

Management and Treatment: Treatment for ureteral calculi depends on the size and location and the substances that make up the stones. It can take several weeks for a stone to pass. During that time, you may need medicine for pain and nausea. If the individual has larger ureteral stones or a urinary tract blockage, following options are advised: 

1. Shock wave lithotripsy: High-energy shock (sound) waves break up stones in ureters into smaller pieces which move through the urinary tract more easily when urinate.
2. Percutaneous nephrolithotomy: A urologist inserts a scope directly into your kidney 

through a small cut (incision) in the back to find and remove large stones. 

1. Ureteral stents: Ureteral stents are thin, flexible, temporary tubes that hold your ureters open. They allow pee to flow around a kidney stone that’s blocking urine flow. These are very helpful in emergency settings.
2. Medical expulsive therapy (MET): MET drugs like alpha-blockers, calcium channel blockers, corticosteroids and phosphodiesterase-5 (PDE5) inhibitors relax the ureter muscles. It works best for treating small ureteral stones near the bladder. Medications used include Acetohydroxamic acid, Allopurinol, Antibiotics, Diuretics, Potassium citrate, Tiopronin etc. 
3. Ureteroscopy: Ureteroscopy is a minimally invasive, outpatient surgical procedure used to treat kidney and ureteral stones without incisions. A surgeon inserts a small, flexible camera (ureteroscope) through the natural urethral opening (in Vagina in women and Penis in Men), breaks up stones with a laser, and removes fragments using a small basket [4,5].                                                                     

Usually performed under general or sometimes spinal anaesthesia. Typically lasts between 30 minutes and 2 hours. No external cuts are made; instruments are passed through the urethra and bladder. If the stone is small, it may be snared with a basket device and removed whole from the ureter. If the stone is large, or if the diameter of the ureter is narrow, the stone will need to be fragmented, which is usually accomplished with a laser. Once the stone is broken into tiny pieces, these pieces are removed. The passage of the ureteroscope may result in swelling in the ureter. Therefore, it may be necessary to temporarily leave a small tube, called a ureteral stent, for 4–7 days to reduce swelling and aid the kidneys drain urine well [4].

Ureteroscopy usually can be performed as an outpatient procedure, however; patients may require an overnight hospital stay if the procedure proves lengthy or difficult. A temporary stent may be placed. Being a Minimally invasive has low infection risk. Effective for stones at any position in the ureter or kidney. Quick recovery, allowing patients to return home the same or next day. Most patients resume normal activity within a few days. While rare, potential complications include pain, bleeding, infection, and damage to the ureter [5].

Recovery time: Most people feel better within a few days after treatment. But some people do have side effects that last until body has passed the last pieces of ureteral stones. In many people, a stone smaller than 4 millimetres pass within one or two weeks. Once a ureteral stone reaches your bladder, it typically passes within a few days.

Many people pass small ureteral stones without treatment. For large ureteral stones, treatments can break up the stone so you can pass it on your own, or a healthcare provider can remove it. Medications can also help remove ureteral stones and prevent them from coming back [7].

Benefits of Timely Treatment of Urolithiasis

Prevention of Urinary Stones: 

1. Drinking more fluids. It’s a good practice to drink at least 3 litres/quarts of fluid each day. Water is best. Other fluids, like lemonade or orange juice, are also good options. 
2. Limit the amount of animal protein in the meals including meat, eggs and fish, which increase the amount of uric acid in the system. Instead eat Lentils, beans, green peas, seitan and tofu, good protein sources that won’t increase the amount of uric acid. 
3. Limit the amount of sodium (salt) in the meals. Consuming less than 1,500 milligrams of salt per day helps reduce chances of developing a ureteral stone. You can replace salt in your diet with salt substitutes, herbs, spices, lemon juice or flavoured vinegars.
4. Limit the amount of oxalate in your meals, by reducing consuming spinach, almonds, cashews and potatoes. Foods and drinks that have a lot of calcium can help prevent oxalate from crystallizing [6].

 Health emergencies, personal ones like Urolithiasis, Acute Appendicitis, Angina, Acue Gastroenteritis and exacerbation of Asthma or COPD and pandemics, natural disasters, and conflict-driven crises severely threaten social commitment by eroding overwhelming health systems approaches and deepening socio-economic inequalities. Urolithiasis one such condition which can arise without any notice especially during hot summer months in India. In personal health emergencies like ureteric stones, the main goal is to stop the severe pain caused by a stone obstructing the ureter. Apart from giving immediate relief, it facilitates future treatment, as a stone inside the kidney is easier to treat using minimal invasive methods, which alleviates pressure on the kidney, reducing the risk of infection and kidney damage.