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Small Ureteric Stone Conservative Management — ESENeph MCQ

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EasyRenal Stone DiseaseSmall Ureteric Stone Conservative ManagementESENeph

A 28-year-old man presents with severe flank pain and visible haematuria. CT KUB shows a 3 mm calculus in the left distal ureter with mild hydronephrosis. He has no fever. eGFR is 95 mL/min/1.73m2. What is the recommended initial management for this stone?

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Correct answer: D — Conservative management with analgesia and medical expulsive therapy

A 3 mm ureteric stone has approximately 80-90% probability of spontaneous passage. NICE NG118 and EAU guidelines recommend conservative management with adequate analgesia (NSAIDs as first-line, with diclofenac 75 mg IM being the gold standard acute analgesic for renal colic, provided no CKD/contraindications) and medical expulsive therapy (alpha-blocker such as tamsulosin 400 mcg daily, though evidence is debated for stones <5 mm). Intervention (ureteroscopy or ESWL) is reserved for: stones >10 mm, failure to pass after 4-6 weeks, uncontrolled pain, infection, or obstruction of a solitary kidney. Nephrostomy is for infected obstructed systems.

Reference: NICE 2019 – NG118 Renal and Ureteric Stones; EAU 2023 – Urolithiasis Guidelines