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Ureteric calculus after uncomplicated ureteroscopy — MSRA MCQ

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HardNephrolithiasisUreteric calculus after uncomplicated ureteroscopyMSRA

A 49-year-old man undergoes elective day-case semirigid ureteroscopy and laser lithotripsy for a 14 mm distal ureteric calculus after unsuccessful shockwave lithotripsy. Preoperative urine culture was negative and renal function was normal. He has two functioning kidneys. At the end of the procedure, all visible fragments have been cleared, contrast drains freely from the collecting system, and there has been no ureteric perforation, significant oedema or need for planned second-look ureteroscopy. Which postoperative urinary drainage plan is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Place no postoperative upper-tract drainage device.

Explanation lettering: C = shown as A · A = shown as B · E = shown as C · B = shown as D · D = shown as E

This is an uncomplicated ureteroscopy for an adult with a ureteric stone smaller than 20 mm. There is complete clearance, free drainage at the end of the procedure, no infection, no obstruction, no ureteric injury, no solitary kidney and no anticipated further procedure. NICE therefore advises against routinely placing a post-treatment ureteric stent in this setting. Stents have no demonstrated routine benefit here and can cause dysuria, haematuria, frequency, urgency, and abdominal or bladder pain. A and B are plausible because short-term stenting is common after ureteroscopy, but neither is indicated after this uncomplicated procedure. D is still less appropriate: a longer dwell time increases stent morbidity and is not justified by any feature in the stem. E would be disproportionate and is reserved for circumstances requiring external upper-tract decompression, not for uncomplicated postoperative drainage. A ureteric stent could become appropriate if there were residual obstruction, infection, a solitary kidney, ureteric trauma, or a need to maintain drainage pending further treatment. Those exceptions have been deliberately excluded.

Reference: NICE NG118: Renal and ureteric stones: assessment and management — Recommendations (2019; last reviewed 2021) — https://www.nice.org.uk/guidance/ng118/chapter/Recommendations NICE NG118 exceptional surveillance decision (2021) — https://www.nice.org.uk/guidance/ng118/resources/2021-exceptional-surveillance-of-urinary-tract-infections-in-under-16s-diagnosis-and-management-nice-guideline-cg54-and-renal-and-ureteric-stones-assessment-and-management-nice-guideline-ng118-9018186157/chapter/Surveillance-decision?tab=evidence