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Ureteric stone with infection — MCCQE Part 1 MCQ

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HardBlood in UrineUreteric stone with infectionMCCQE Part 1

A 45-year-old man presents with right flank pain radiating to the groin and visible haematuria. Temperature is 38.6°C, heart rate is 112/min, and urinalysis shows nitrites and leukocytes. CT shows a 7 mm obstructing distal ureteric stone with hydronephrosis. What is the most appropriate next step in management?

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Correct answer: D — Start intravenous antibiotics and arrange urgent urinary decompression

An obstructing ureteric stone with fever and infected urine is a urologic emergency requiring antibiotics and decompression by stent or nephrostomy. Medical expulsive therapy is reasonable for selected uncomplicated stones, but not with sepsis or obstruction. Delayed lithotripsy without drainage risks septic deterioration.

Reference: Canadian Urological Association ureteral calculi guidance