Ans. a (Dietl's crisis). (Ref. Bailey and Love, 25th/pg.l293)Position of stoneSite of PainAt PUJ or upper ureterPain radiates to the testiclesAt middle of the ureter (i.e. at crossing of gonadal vessels and ureter)Pain is referred to Me Burneys point on the right side resembling appendicitis and on left side simulates diverticulitis.At lower ureter or at pelvic brimPain is referred to inner side of thighIn the intramural ureterStrangury (painful and fruitless desire to micturate.UNILATERAL HYDRONEPHROSISThe female:male ratio of unilateral hydronephrosis (most commony caused by idiopathic pelviureteric junction obstruction or calculus) is 2:1; the right side is more commonly affected.Presenting features include the following.# Insidious onset of mild pain or dull aching in the loin. There is often a sensation of dragging heaviness which is made worse by excessive fluid intake. An enlarged kidney may be palpable if the cause is pelviureteric junction obstruction.# Attacks of acute renal colic may occur with no palpable swelling.# Intermittent hydronephrosis. After an attack of acute renal pain a swelling in the loin is found. Some hours later, following the passage of a large volume of urine, the pain is relieved and the swelling disappears (Dietl's crisis)Some important termsCHILAIDUI'S SYNDROMEColonic loop between liver and diaphragm (pseudoperitoneum)--Chilaiditi's syndromeDIETL'S CRISISAfter an attack of acute renal pain a swelling in loin is found. Sometimes later, following the passage of large volume of urine, the pain is relieved and swelling disappears. This is Dietl's crisis, a feature of intermittent hydronephrosis, is seen in PUJ obstruction.STRANGURYWhen the stone is in the intramural ureter, the pain is referred to the tip of the penis. In both sexes there may be strangury.STEINSTRASSEImmediately after ESWL, the treated stone may look larger, appear less dense, and have margins that are more indistinct. The fragments may disperse and conform to the shape of the pelvicalyceal system or ureter. Multiple small stone fragments that columnize in the ureter are common and are known as Steinstrasse, or "street of stone". Ureteral obstruction may occur from a solitary fragment or from Steinstrasse.OLIGURIALess than 300 ml of urine is excreted in a day.MEGENBLASSEDistension of Splenic flexure causing pain due to heavy fatty diet.METEORISMAbdominal distension 24--48 hours after renal injury is probably due to retroperitoneal haematoma implicating splanchnic nerves.MITTELSCHMERZPain ovulation with abdominal discomfort at regular intervals, usually about 14th day and may be associated with spotting due to estrogen withdrawal.