In the management of upper ureteric calculus (7 mm), which treatment option is associated with the highest single-session stone-free rate when the stone is at the ureteropelvic junction level?

• A Extracorporeal shock wave lithotripsy (ESWL)
• B Percutaneous nephrolithotomy (PCNL)
• C Medical expulsive therapy with tamsulosin
• D Ureteroscopy with holmium laser lithotripsy (URS-LL) ✓

Explanation

For a 7 mm upper ureteric stone, ureteroscopy with holmium laser lithotripsy achieves the highest single-session stone-free rate (~90–95%), superior to ESWL (~60–70%) which is less effective for ureteric stones, particularly proximal stones. PCNL is reserved for renal calculi or complex cases. Medical expulsive therapy with alpha-blockers is appropriate for stones ≤5 mm in the distal ureter. EAU and NEET PG guidelines consistently favour URS for ureteric stones 5–10 mm with a high single-treatment success rate.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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