A 10-mm calculus in the right lower ureter associated with proximal hydroureteronephrosis is best treated with:
Answer is D (Ureteroscopic Retrieval) : The patient in question has a small calculus (1.0 cm) in size, which is located in the distal ureter and hence is amenable to ureteroscopic removal. The presence of proximal hydroureteronephrosis indicates obstruction and forms- the indication for clone removal. Indications and mahods for removal of stone Indications for stone removal Repeated attacks of colic Stone is too large to pass Stone is enlarging Stone is not moving Stone is causing complete obstruction of the kidney Urine is infected Ureteroscopic Removal Small stone Stone in lower pa of ureter within 5-6 cm of ureteric orfice Extracorporal shock wave Lithotripsy Best for proximal stones that can be identified by the imaging system of Lithotriptor Stones in miduretor can be pushed up in the pelvis and then exposed to shock waves Not appropriate if complete obstruction is present Stones < 2.0 to 2.5 cm can be removed Percutaneous Nephrolithotripsy It is done for proximal ureteric cacluli Stones > 2.5 cm, those that are resistant to shock waves Open Surgery is done very rarely nowadays when all methods have failed, Urethrolithotomy is done for long standing calculi not accessible by instruments and ESWL.
Extracorporeal shockwave lithotripsy
Antegrade percutaneous access
Open ureterolithotomy
Ureteroscopic retrieval