Infected obstructed ureteric stone — MSRA MCQ

Correct answer: C — Arrange emergency admission for intravenous antimicrobial therapy and urgent upper-tract decompression, deferring stone clearance

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

This is an infected obstructed kidney: she has a CT-confirmed obstructing ureteric stone with hydronephrosis, systemic features of infection (rigors, fever and tachycardia) and evolving acute kidney injury. This is a urological emergency. She requires immediate hospital management, antimicrobial treatment and urgent decompression of the obstructed upper urinary tract (typically by ureteric stent or percutaneous nephrostomy according to local expertise and anatomy). Definitive stone treatment should be deferred until sepsis has been controlled. A is inappropriate because shockwave lithotripsy does not provide reliable immediate source control in infected obstruction. C is attractive because ureteroscopy can treat ureteric stones definitively, but instrumentation and lithotripsy are not the initial priority in obstructive sepsis; drainage is required first. D is unsafe because outpatient antibiotics do not address the obstructed, infected collecting system or her physiological instability. E would be reasonable to consider only for a stable adult with a distal ureteric stone smaller than 10 mm and no infective or renal-function complication; it is not appropriate here.

Reference: NICE NG118: Renal and ureteric stones: assessment and management, Overview (Published 2019; last reviewed 2021) — https://www.nice.org.uk/guidance/ng118 Renal Colic Referral Pathway (Accessed 15 August 2026) — https://www.rightdecisions.scot.nhs.uk/nhsl-referral-pathways/urology-referral-pathways/renal-colic-referral-pathway/