skip to main content

Uncomplicated distal ureteric calculus — MSRA MCQ

Instant feedback + full explanation. One question, done properly.

ModerateNephrolithiasisUncomplicated distal ureteric calculusMSRA

A 37-year-old woman is assessed in an urgent treatment centre with 12 hours of right-sided renal colic. Low-dose non-contrast CT shows a single 7 mm distal right ureteric calculus. She is afebrile, haemodynamically stable and has normal renal function. Urine dipstick is positive for blood but negative for nitrites and leucocytes. Her pain is controlled with oral diclofenac and paracetamol, and she is able to drink. A pregnancy test is negative. She has no history of postural hypotension or liver disease. What is the most appropriate management plan on discharge?

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

Reveal the answer and explanation

Correct answer: E — Consider an alpha blocker as off-label medical expulsive therapy, with analgesia and safety-netting advice

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

This patient has an uncomplicated distal ureteric stone measuring less than 10 mm: she has no sepsis, acute kidney injury, solitary-kidney scenario or uncontrolled pain. NICE recommends considering an alpha blocker for adults with distal ureteric stones under 10 mm. This is medical expulsive therapy (MET), used alongside appropriate analgesia and clear advice to seek urgent review for fever, rigors, worsening or intolerable pain, vomiting preventing oral intake, or reduced urine output. Alpha-blocker use for stone passage is off-label, so this should be discussed when prescribing. B and C are premature. NICE recommends intervention within 48 hours when pain is ongoing and intolerable, or the stone is unlikely to pass; neither threshold is established here. For a ureteric stone below 10 mm, SWL is ordinarily the first procedural option if intervention is required, with URS reserved where SWL cannot achieve clearance within 4 weeks, is contraindicated, not targetable, or has failed. D is attractive because calcium-channel blockers have historically been used for MET, but current NICE guidance recommends alpha blockers rather than nifedipine. E is acceptable supportive care in some patients, but misses the guideline-supported option of MET for this distal 7 mm stone.

Reference: NICE NG118: Renal and ureteric stones: assessment and management — Medical expulsive therapy (2019) — https://www.nice.org.uk/guidance/ng118/chapter/Recommendations NICE NG118: Renal and ureteric stones: assessment and management — Timing of surgical treatment (2019) — https://www.nice.org.uk/guidance/ng118/chapter/recommendations NICE NG118: Renal and ureteric stones: assessment and management — Surgical treatment of ureteric stones (2019) — https://www.nice.org.uk/guidance/ng118/chapter/recommendations