Which of the following is the treatment of choice in a patient with a 10-mm calculus in the right lower ureter associated with proximal hydroureteronephrosis?
**Core Concept**
The management of ureteral calculi involves addressing the obstruction caused by the stone, which can lead to complications such as renal impairment and infection. In this scenario, a 10-mm calculus in the right lower ureter is causing proximal hydroureteronephrosis, necessitating prompt treatment to prevent further complications.
**Why the Correct Answer is Right**
The treatment of choice for a ureteral calculus causing significant obstruction is ureteroscopy with stone extraction. This minimally invasive procedure involves passing a small scope through the urethra and bladder into the ureter, where the stone can be visualized and removed using a laser or other tools. This approach is particularly effective for stones in the lower ureter, as it allows for direct visualization and manipulation of the stone. Additionally, ureteroscopy has a high success rate and can be performed on an outpatient basis.
**Why Each Wrong Option is Incorrect**
**Option A:** **Percutaneous Nephrolithotomy (PCNL)** is a more invasive procedure typically reserved for larger stones (>2 cm) or those located in the renal pelvis. It is not the preferred treatment for a 10-mm calculus in the lower ureter.
**Option B:** **Shock Wave Lithotripsy (SWL)** is a non-invasive procedure that uses shock waves to break up stones, but it is less effective for stones in the lower ureter and may require multiple sessions.
**Option C:** **Open Surgery** is a more invasive approach that is rarely used for ureteral calculi, as it carries a higher risk of complications and is typically reserved for complex cases.
**Clinical Pearl / High-Yield Fact**
In patients with ureteral calculi, it is essential to assess the severity of the obstruction and the presence of any complications, such as infection or renal impairment, before selecting a treatment approach.
**Correct Answer:** C. Open Surgery