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Ureteric Calculus — RACP Adult Medicine MCQ

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ModerateNephrologyUreteric CalculusRACP Adult Medicine

A 35-year-old man presents with sudden onset flank pain and haematuria. CT KUB shows a 7 mm ureteric calculus in the left proximal ureter with mild hydronephrosis. He is afebrile with normal renal function. Pain is controlled with NSAIDs. What is the most appropriate management?

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Correct answer: B — Medical expulsive therapy (tamsulosin) and observation for 4 weeks

For ureteric stones 5–10 mm without signs of infection, obstruction with renal impairment, or uncontrolled pain, conservative management with medical expulsive therapy (tamsulosin 400 mcg daily) is appropriate for up to 4–6 weeks. Tamsulosin relaxes ureteral smooth muscle and facilitates spontaneous passage. The probability of spontaneous passage for 5–10 mm stones is approximately 50%. Intervention is required if the stone fails to pass, or if infection, worsening obstruction, or renal deterioration occurs.

Reference: eTG – 2025 – Urology; EAU – 2024 – Urolithiasis Guidelines