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Ureteric calculus after uncomplicated ureteroscopy — MSRA MCQ

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HardNephrolithiasisUreteric calculus after uncomplicated ureteroscopyMSRA

A 47-year-old woman undergoes elective ureteroscopy (URS) for a 13 mm proximal ureteric calculus. Pre-operative urine culture was negative and renal function was normal. At URS, the stone is completely removed. There is no ureteric perforation or significant mucosal trauma, retrograde assessment shows free drainage, and no further endoscopic treatment is anticipated. She is afebrile, has a normal contralateral kidney and no residual obstruction. What is the most appropriate post-operative plan regarding ureteric stenting?

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Correct answer: C — Do not insert a post-treatment ureteric stent routinely.

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

This was an uncomplicated URS for an adult ureteric stone measuring less than 20 mm. The stone has been fully removed, drainage is satisfactory, and there is no infection, residual obstruction, solitary kidney or anticipated further procedure. NICE therefore advises against routine post-treatment stenting in this setting. Evidence reviewed by NICE found no benefit from routine stenting after URS for ureteric stones smaller than 20 mm, while stents increase dysuria, haematuria, urinary frequency, urgency and pain. B is attractive because proximal stones may be perceived as having greater risk of post-operative obstruction, but stone location alone is not an indication for a stent after uncomplicated URS. C incorrectly uses stone size above 10 mm as a threshold; the relevant NICE threshold is less than 20 mm. D would be reasonable if obstruction persisted or drainage were uncertain, neither of which applies. E reflects a common prophylactic practice but is not supported routinely after uncomplicated URS. Stenting may be appropriate where infection, obstruction, a solitary kidney, a significant complication or planned further treatment is present.

Reference: Renal and ureteric stones: assessment and management (NG118), recommendations (Published 08 January 2019; checked 2026) — https://www.nice.org.uk/guidance/ng118/chapter/recommendations Renal and ureteric stones: evidence review on stent use after surgery (NICE evidence review; checked 2026) — https://www.nice.org.uk/guidance/ng118/documents/evidence-review-10