A 45-year-old man presents with sudden-onset severe left loin pain radiating to the groin. CT KUB reveals a 5 mm calculus at the left vesico-ureteric junction (VUJ). Serum creatinine is normal. What is the most appropriate initial management?
- A Immediate ureteroscopy and laser lithotripsy
- B Extracorporeal shock wave lithotripsy (ESWL)
- C Conservative management with analgesia and alpha-blocker (tamsulosin) for medical expulsive therapy ✓
- D Percutaneous nephrostomy decompression
Correct answer: C. Conservative management with analgesia and alpha-blocker (tamsulosin) for medical expulsive therapy
Explanation
A 5 mm distal ureteric stone has approximately 70% spontaneous passage rate within 4 weeks. Medical expulsive therapy (MET) with an alpha-blocker (tamsulosin) is first-line for stones ≤10 mm with adequate renal function and controlled pain. EAU guidelines support conservative management with MET for distal stones ≤10 mm in the absence of infection, obstruction of a solitary kidney, or intractable pain. Ureteroscopy is reserved for failed conservative management, infection, or obstruction.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.