# Giant Distal Ureteric Calculus in a Tertiary Care Center: Our Experience

## TL;DR

This study shares the authors' experience treating large stones in the lower ureter using open surgery, showing it is safe and effective when other methods fail.

## Contribution

The paper presents a case series on managing giant distal ureteric calculi through open ureterolithotomy at a tertiary care center.

## Key findings

- All seven patients had complete stone clearance with no residual fragments after open ureterolithotomy.
- Fever was observed in 85.7% of patients, and 42.9% had positive urine cultures.
- Open ureterolithotomy was found to be a safe and effective treatment with minimal complications.

## Abstract

Objective: This study aimed to describe the clinical presentation, diagnostic evaluation, and management of giant distal ureteric calculi at a tertiary care center.

Methodology: This retrospective case series included seven adult patients with distal ureteric calculi measuring >5 cm who were treated at a tertiary care facility between December 2023 and August 2024. Patients presenting with sepsis or acute renal impairment were excluded. All patients underwent comprehensive clinical evaluation and radiological assessment using ultrasonography and contrast-enhanced computed tomography, followed by open ureterolithotomy. Postoperative outcomes, including stone clearance and procedure-related complications, were documented.

Results: The mean age of the patients was 45.1 ± 19.3 years (range: 12-69 years). Females comprised five patients (71.4%) of the study population. The mean stone size was 5.81 ± 0.43 cm. Fever was observed in six (85.7%) patients, and three (42.9%) had positive urine cultures. Hydroureteronephrosis was present in all patients (7/7, 100%). Complete stone clearance was achieved in all cases following open ureterolithotomy, with no residual fragments or significant postoperative complications.

Conclusion: Open ureterolithotomy was a safe and effective treatment option for giant distal ureteric calculi, providing complete stone removal with minimal perioperative morbidity, particularly when minimally invasive approaches are not feasible or have failed.