A 2 yo pt presents with colicky pain which radiates from loin to groin. He complains of similar
episodes in the past. Inv has been done and 7mm stone was found in the ureter. What is the
most appropriate management?
a. Percutaneous nephrolithiotomy
b. Open surgery
c. Ureteroscopy or laser
d. Conservative tx
e. ESWL
Q. 1. What is the key?
Q. 2. What treatments are recommended for different sized stones in Adults?
Ans. 1. The key is E. ESWL. Probably a wrong key! The correct key is C. Ureteroscopy or laser. [For 6-16
mm stone in pediatric group ureteroscopy is the treatment of choice. So answer here is C. Ureteroscopy
or laser].
Ans. 2. Stones < 5mm: pass spontaneously, Increase fluid intake.
Stones 5mm-10mm /pain not resolving: medical expulsive therapy—> Nifedipine or Tamsulosin(and/or
prednisolone).
Stones 10mm-2cm: ESWL or Ureteroscopy using dormia basket.
Stones > 2cm/large/multiple/complex: Percutaneous nephrolithotomy.