A 75-year-old male patient presented with severe right flank pain and was diagnosed with a large distal ureteral stone measuring over 1 cm in diameter. Imaging also revealed significant hydronephrosis of the right kidney, indicating urinary obstruction requiring urgent treatment.
The patient had multiple comorbidities, including diabetes mellitus and a history of coronary stent placement. He was also taking antiplatelet and anticoagulant medications. Despite these risk factors, ureteroscopic stone removal (URSL), a minimally invasive endoscopic procedure, was selected as a safe and effective treatment option. URSL is widely used to remove ureteral stones while preserving kidney function and rapidly relieving pain.
The procedure began with cystoscopic insertion of a ureteral catheter into the ureteral orifice. A guidewire was then advanced into the kidney, followed by insertion of a ureteroscope. In this case, a rigid ureteroscope was used to locate the stone. A holmium laser was applied to fragment the stone, and the fragments were removed using a retrieval basket. The procedure required meticulous technique to minimize ureteral mucosal injury. Despite potential challenges in visualization depending on ureteral anatomy, complete stone removal was successfully achieved.
After the procedure, a ureteral stent was placed to prevent postoperative edema and to facilitate the natural passage of any residual fragments. The stent typically does not cause significant discomfort and can be easily removed after approximately two weeks. Follow-up evaluation confirmed complete stone clearance, and the patient’s kidney function returned to normal.
Among various treatment options for urinary stones, URSL is considered a safe and effective approach, even in elderly patients or those with underlying medical conditions. In this case, despite cardiovascular disease and diabetes, the patient was able to undergo the procedure without significant risk. The placement of a ureteral stent also helped minimize postoperative discomfort and supported recovery.
Preventing recurrence is a critical part of long-term management. Urinary stones are associated with a high recurrence rate, making adequate hydration, dietary modification, and regular physical activity essential. In this patient, stone analysis identified calcium oxalate as the primary component. Based on this result, dietary recommendations included reducing intake of oxalate-rich foods while maintaining sufficient fluid intake.
This case highlights how URSL can be safely and effectively performed to relieve severe pain and prevent kidney damage caused by ureteral stones. Early diagnosis and timely treatment are essential to avoid complications. When symptoms of urinary stones first appear, prompt evaluation and appropriate management are the most effective strategies for maintaining long-term urinary health and overall well-being.