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Uncomplicated distal ureteric calculus with planned cataract surgery — MSRA MCQ

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HardNephrolithiasisUncomplicated distal ureteric calculus with planned cataract surgeryMSRA

A 69-year-old man presents to an urgent treatment centre with CT-confirmed renal colic from a 4 mm distal left ureteric calculus. He is afebrile, haemodynamically stable and has normal renal function. Urine dipstick is positive for blood but negative for nitrites and leucocytes. His pain is controlled with oral diclofenac and paracetamol, and he is drinking adequately. He is scheduled for phacoemulsification cataract surgery in 5 days. There is no indication for immediate stone intervention. What is the most appropriate management plan?

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

Reveal the answer and explanation

Correct answer: D — Discharge with oral analgesia and safety-netting, without starting medical expulsive therapy before cataract surgery

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

This man has an uncomplicated small distal ureteric stone: he has controlled pain, no features of urinary infection or sepsis, preserved renal function and no indication for urgent decompression or definitive intervention. NICE advises that alpha blockers may be considered for distal ureteric stones smaller than 10 mm. However, this is an exception: tamsulosin should not be initiated in patients for whom cataract or glaucoma surgery is scheduled because of the association with intraoperative floppy iris syndrome (IFIS). Simply informing the cataract surgeon does not remove this prescribing precaution. Therefore, conservative management with analgesia, hydration as tolerated and clear return precautions is most appropriate until the planned ophthalmic procedure has passed. B is attractive because the stone is distal and below 10 mm, but planned cataract surgery makes starting tamsulosin inappropriate. C is plausible because calcium-channel blockers have historically been used for stone passage, but NICE recommends alpha blockers rather than nifedipine for medical expulsive therapy. D and E would be appropriate if pain were ongoing and intolerable, the stone were judged unlikely to pass, or complications such as infection or renal impairment developed; none applies here.

Reference: NICE NG118: Renal and ureteric stones: assessment and management — Recommendations (2019) — https://www.nice.org.uk/guidance/ng118/chapter/Recommendations Tamsulosin Milpharm 400 micrograms prolonged-release tablets — Summary of Product Characteristics (25 June 2026) — https://www.medicines.org.uk/emc/product/102038/smpc