A large PUJ calculus

This adult male patient had a large left pelvi-ureteral junction calculus. 

The ultrasound findings are described below:

• Ultrasound findings:
  • A large, echogenic calculus measuring 2 x 1 cms is seen at the left pelvi-ureteral junction.
  • The calculus is causing moderate hydronephrosis of the left kidney.
  • There is no evidence of obstruction of the ureter distal to the calculus.
  • A prominent acoustic shadow is present. 
  • Color Doppler ultrasound revealed absence of twinkle artefact. Twinkle artefact is not always present even in such a large calculus. 
  • It is important to image the kidney and the calculus in both long section and transverse section also. This helps get a multidimensional view of the renal stone. 
• Prognosis:
  • The prognosis for this condition is generally good.
  • In most cases, the calculus will pass spontaneously within a few weeks.
  • If the calculus does not pass spontaneously, it can be treated with minimally invasive procedures such as extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy.
• Management:
• The initial management of this condition is usually conservative.
• This may involve pain medication, antibiotics, and increased fluid intake.
• If the calculus does not pass spontaneously within a few weeks, then more invasive treatment may be necessary.
• The specific treatment approach will be determined by the size and location of the calculus, as well as the patient's individual medical history.

Ultrasound images are shown below:

What are the chances of this calculus spontaneously being ejected?

The chances of a 2x1 cm renal calculus passing down spontaneously are low, estimated to be around 5%. This is because the stone is larger than 1 cm and is lodged at the pelvi-ureteral junction, which is a narrow part of the ureter where stones are more likely to get stuck.

If the stone does not pass spontaneously, it may require treatment, such as:

* Medications to help break up the stone

* Ureteroscopy, a procedure in which a thin tube with a camera is inserted into the ureter to remove the stone

* Percutaneous nephrolithotomy, a procedure in which a small incision is made in the back and a tube is inserted into the kidney to remove the stone

The best course of treatment for a 2x1 cm renal calculus will depend on the individual patient's circumstances and the doctor's assessment.

Here are some additional information:

* The size of the stone is the most important factor in determining whether it will pass spontaneously. Stones smaller than 5 mm are more likely to pass than stones larger than 10 mm.

* The location of the stone can also affect the chances of it passing spontaneously. Stones that are lodged in the ureter are less likely to pass than stones that are still in the kidney.

* Other factors that can affect the chances of a stone passing spontaneously include the patient's age, health, and activity level.

It is important to see a doctor to discuss your treatment options.

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Ultrasound imaging of renal calculi