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Difficulty: MediumUrologic Surgery

Match each clinical presentation of urolithiasis with the most appropriate definitive surgical or procedural management.

  • A 42-year-old man with severe pain and an 8-mm distal ureteral calculus that has not passed after 4 weeks of observationUreteroscopy with laser lithotripsy
  • A 55-year-old woman with a 2.8-cm staghorn calculus in the right kidney and a normal contralateral kidneyPercutaneous nephrolithotomy (PCNL)
  • A 65-year-old man with a 6-mm proximal ureteral stone, fever of 39.0°C (102.2°F), and leukocytosisUrgent ureteral stent or percutaneous nephrostomy tube placement
  • A 38-year-old woman with a 1.2-cm stone in the left renal pelvis who desires an outpatient, non-endoscopic treatmentExtracorporeal shock wave lithotripsy (ESWL)

Answer

Distal stone failing MET matches to Ureteroscopy; Staghorn calculus matches to PCNL; Infected obstructing stone matches to Urgent decompression; Renal pelvic stone < 2 cm matches to ESWL.
The correct pairings align the stone characteristics (size, location) and clinical context (infection, patient preference) with the standard urological guidelines for urolithiasis management.

Step-by-Step Solution

1
Evaluate stone size and location.
Determines whether the stone is likely to pass spontaneously or requires surgical intervention.
Stone size (e.g., > 10 mm) and location directly dictate the choice between ESWL, URS, and PCNL.
2
Assess for signs of infection or acute renal failure.
Identifies if the situation is a urologic emergency.
Infected, obstructing stones require emergent decompression rather than definitive stone fragmentation to prevent sepsis.
3
Match specific patient preferences and stone characteristics to the optimal procedure.
Selects ESWL for non-invasive preference, URS for distal stones, and PCNL for large stone burden.
Tailors the surgical approach to optimize stone-free rates while minimizing patient morbidity.

Key Concept

Surgical Management of Urolithiasis based on Size, Location, and Complications
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Topics

Urologic Surgery

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