Which of the following is the treatment of choice for lower ureteric stone-
## **Core Concept**
The treatment of lower ureteric stones depends on the size, location, and composition of the stone, as well as the patient's overall health. The goal is to relieve obstruction, manage pain, and prevent complications such as infection or kidney damage. **Ureteroscopy** is a commonly used procedure for managing ureteric stones.
## **Why the Correct Answer is Right**
The correct answer, **D. Ureteroscopy (with laser lithotripsy)**, is considered the treatment of choice for lower ureteric stones because it is highly effective for immediate stone clearance. Ureteroscopy involves passing a small scope through the bladder and into the ureter to directly visualize the stone. **Laser lithotripsy** can then be used to break the stone into smaller pieces that can be removed or passed spontaneously. This method is preferred for lower ureteric stones due to its high success rate and lower risk of complications compared to other treatments.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is incorrect because, although **Extracorporeal Shock Wave Lithotripsy (ESWL)** can be used for ureteric stones, it is generally more effective for smaller stones in the upper ureter or renal pelvis. Its effectiveness decreases for larger stones or those located in the lower ureter.
- **Option B:** This option is incorrect because **Open ureterolithotomy** is a more invasive surgical procedure that was historically used for ureteric stones but is now rarely performed due to the availability of less invasive and highly effective techniques like ureteroscopy.
- **Option C:** This option is incorrect because, although **Medical expulsive therapy** (using medications like alpha-blockers) can help facilitate the passage of small ureteric stones, it is not sufficient for larger stones or those causing significant obstruction.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that the management of ureteric stones is often guided by the **stone's location** (upper, mid, or lower ureter), **size**, and **patient factors**. Ureteroscopy with laser lithotripsy is particularly valuable for lower ureteric stones due to its high efficacy and safety profile.
## **Correct Answer:** D. Ureteroscopy.