A giant ureteral stone in a young adult: A case report

Abstract

A large ureteral stone is a rare condition that can cause significant complications if untreated. We report the case of a 21-year-old male from Farah province who experienced abdominal pain for eight months, with localized lower abdominal pain for the last two months, and frequent urination but no hematuria. Imaging revealed a 9 × 4 cm stone lodged in the lower ureter. The patient underwent ureterolithotomy, and a double J stent was placed. Postoperative outcomes were excellent. Stones larger than 10 cm are exceptionally rare, and this case emphasizes the need for prompt diagnosis despite atypical symptoms.

1 Introduction

Ureteral stones occur in various anatomical locations within the urinary system. They are commonly found in three narrow areas of the ureter. Patients with ureteral stones usually present with flank pain or hematuria. However, atypical symptoms such as abdominal pain, urinary urgency, heartburn, vomiting, frequent urination, and testicular pain can also occur. The likelihood of spontaneous passage depends on the stone’s size and location within the ureter (proximal, middle, or distal). Generally, ureteral stones with a diameter greater than 10 mm are unlikely to pass on their own, necessitating intervention for most patients. Extracorporeal shock wave lithotripsy (SWL) and transurethral lithotripsy (TUL) are the primary treatment methods for ureteral stones. Studies show varying rates of spontaneous stone passage based on the stone size, with stones larger than 10 mm in diameter rarely passing without intervention (87 % [1 mm]; 76 % [2–4 mm]; 60 % [5–7 mm]; and 48 % [7–9 mm]). Additionally, the spontaneous passage rate for stones in the distal ureter and the junction of the ureter with the bladder is higher than for stones in the middle and proximal ureter. However, some ureteral stones progress silently until they exceed 10 cm in length or weigh more than 50 g. These types of stones are called large ureteral stones and are very rare. Most urinary system stones are composed of calcium oxalate or calcium phosphate. Other types include struvite, magnesium, uric acid, and cystine stones. This report discusses a rare case of a large distal left ureteral stone causing hydronephrosis without metabolic or anatomical anomalies.

2 Case presentation

A 21-year-old male from Farah province presented with abdominal pain for eight months and pain in the left lower abdomen for two months. He reported frequent urination and urgency but no change in urine color. He was admitted to the emergency department of Tabiban Hospital. He had a history of left kidney stone surgery but no family history of urinary system stones. He used acetaminophen for pain relief.

3 Imaging

Ultrasound revealed hydronephrosis and hydroureter ( Fig. 1 ). A KUB X-ray identified a large stone in the left ureter ( Fig. 2 ). IVP confirmed left kidney function.

4 Laboratory examinations

Initial tests showed a urinary tract infection caused by E. coli , which was treated with ciprofloxacin. Subsequent urine culture was negative. Urine biochemistry results were as follows: urea 40 mg/dl, creatinine 1 mg/dl, blood urea nitrogen 16 mg/dl, hemoglobin 14.2 mg/l, and normal sodium, potassium, plasma calcium, and phosphorus.

5 Surgery

The patient underwent open ureterolithotomy using a Gibson incision. A 9 × 4 cm stone was removed ( Fig. 3 ), and a double J stent was applied. The patient was discharged after five days without any complications.