A 2 yo pt presents with colicky pain which radiates from loin to groin. He complains of similar
episodes in the past. Inv has been done and 7mm stone was found in the ureter. What is the
most appropriate management?
a. Percutaneous nephrolithiotomy
b. Open surgery
c. Ureterscopy or laser
d. Conservative tx
e. ESWL
Answer: E
TTT of urinary stones in adults
< 5mm = conservative
renal stones
>2cm PCNL
<2cm ESWL
ureter >7mm
ESWL 1st line
Ureterscopy 2nd line
PCNL 3rd line
Bladder >7mm
Transurtheral removal
Cystolithoplaxy
GOLD standard INV: non contrast helical CT
in children, U/S, KUB maybe enough to avoid radiation exposure
nb cystine/uric acid stones should be treated with urine alkalinization... bicarbonate, potassium
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