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General Surgery · Urology: medical expulsive therapy
Sample itemA patient with an uncomplicated 6 mm distal ureteric stone has controlled pain, normal renal function and no infection. What is a reasonable management?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. Analgesia with an alpha blocker such as tamsulosin and observation
Stones under 10 mm in the distal ureter often pass spontaneously, and alpha blockers relax ureteric smooth muscle to promote passage. NSAIDs give effective analgesia. Intervention is needed for infection, obstruction with renal impairment, intractable pain or failure to pass.
Option by option
A. Analgesia with an alpha blocker such as tamsulosin and observation (correct)
Correct. Conservative treatment with medical expulsive therapy is appropriate.
B. Immediate open ureterolithotomy
Open surgery is obsolete for such a stone.
C. Nephrectomy
Nephrectomy is not warranted.
D. Percutaneous nephrolithotomy
PCNL is for large renal stones.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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