Symptomatic distal ureteric calculus — MSRA MCQ

Correct answer: E — Arrange ureteroscopy within 48 hours of diagnosis

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

This patient requires definitive intervention within 48 hours because he has a ureteric stone with ongoing, intolerable renal colic despite appropriate analgesia. For adult ureteric stones smaller than 10 mm, NICE recommends shockwave lithotripsy (SWL) as first-line treatment, but ureteroscopy (URS) should be considered where the stone is not targetable with SWL. Therefore, urgent URS is the appropriate option. A is initially attractive because the stone is below 10 mm and alpha blockers may be considered for distal ureteric stones. However, medical expulsive therapy is not appropriate as sole management when pain remains uncontrolled and intervention is indicated. B would ordinarily be appropriate for a targetable ureteric stone under 10 mm, but is excluded here by the lithotripsy assessment. C may be used as temporary drainage in selected circumstances, such as infected obstruction or where definitive treatment cannot promptly be delivered, but it does not provide the indicated definitive treatment in this stable patient. D is unnecessarily invasive; PCNL is not standard treatment for an uncomplicated 8 mm distal ureteric stone.

Reference: Renal and ureteric stones: assessment and management (NG118), Recommendations (Published 2019; checked 2026) — https://www.nice.org.uk/guidance/ng118/chapter/Recommendations Renal and ureteric stones: assessment and management (NG118), Recommendations (Published 2019; checked 2026) — https://www.nice.org.uk/guidance/ng118/chapter/Recommendations