## Clinical Context This patient has an uncomplicated ureteric stone with normal renal function, no infection, and no complete obstruction (only mild hydronephrosis). ## Management Algorithm for Ureteric Stones **Key Point:** Stone size, location, and presence of complications determine management strategy. ```mermaid flowchart TD A[Ureteric stone diagnosed]:::outcome --> B{Stone size?}:::decision B -->|< 6 mm| C{Symptoms controlled?}:::decision B -->|6-10 mm| D{Obstruction + fever?}:::decision B -->|> 10 mm| E[Intervention required]:::action C -->|Yes, no fever| F[Conservative: hydration, analgesia, NSAIDs]:::action C -->|No or fever| G[Intervention: URS ± lithotripsy]:::action D -->|No| F D -->|Yes| H[Urgent decompression: DJ stent or PCN]:::urgent F --> I[Follow-up NCCT in 4 weeks]:::action I --> J{Stone expelled?}:::decision J -->|Yes| K[Success]:::outcome J -->|No| G ``` ## Rationale for Conservative Management **High-Yield:** Stones ≤6 mm have a 90% spontaneous passage rate within 4 weeks. Stones 6–10 mm have a 50% passage rate. **Clinical Pearl:** Absence of fever, normal renal function, and controlled pain are prerequisites for conservative management. NSAIDs (e.g., indomethacin) reduce ureteric peristalsis and pain; alpha-blockers (tamsulosin) improve passage rates by relaxing the ureteric musculature. **Key Point:** Intervention (ureteroscopy) is reserved for: - Stones >10 mm - Failure of spontaneous passage after 4–6 weeks - Uncontrolled pain or recurrent symptoms - Fever or signs of infection (pyelonephritis) - Complete obstruction with renal dysfunction ## Supportive Measures - Aggressive hydration (2–3 L/day) to increase urine flow - Analgesia: NSAIDs (first-line), opioids if needed - Antiemetics for nausea - Straining of urine to recover stone for analysis [cite:Harrison 21e Ch 283]
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