A 40-year-old female presents with right lower quadrant colicky pain radiating to the labia majora, accompanied by gross hematuria. Non-contrast helical CT reveals a 4 mm stone in the distal right ureter without hydronephrosis or infection. What is the initial management?

Answer and explanation

Correct answer: C. Medical expulsive therapy with hydration, analgesia, and tamsulosin

  1. Step 1: Ureteral stones measuring less than 5 mm have an 80-90% probability of spontaneous passage.
  2. Step 2: In the absence of infection, intractable pain, or bilateral obstruction, initial management consists of medical expulsive therapy (hydration, NSAIDs for pain, and alpha-1 blockers like tamsulosin to relax ureteral smooth muscle).
  3. Step 3: Invasive procedures are reserved for larger stones (> 10 mm) or complicated obstruction.
Answer
Medical expulsive therapy with hydration, analgesia, and tamsulosin.
Why not the others: 'Emergent open ureterolithotomy' is obsolete for uncomplicated 4 mm stones; 'Immediate extracorporeal shock wave lithotripsy (ESWL)' is an elective intervention for larger proximal stones; 'Percutaneous nephrostomy tube placement' is indicated for infected obstructed kidneys with sepsis.

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A 40-year-old female… | Oman Medical Specialty Board Examination (OMSB)