Kidney-sparing management of a giant distal ureteric stone: A case report

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INTRODUCTION AND IMPORTANCE: Giant distal ureteric stones are rare and pose significant treatment challenges due to their size and associated risk of renal impairment. While nephrectomy is often considered, kidney-sparing strategies may offer functional preservation, especially when aligned with patient preferences. PRESENTATION OF CASE: A 75-year-old male with comorbid hypertension and gout was found to have a 5.6 × 2.8 cm distal ureteric stone causing severe hydronephrosis and cortical thinning. Despite initial consideration for nephrectomy, the patient opted for a kidney-preserving approach. He underwent staged interventions, including ureteroscopy with laser lithotripsy, nephrostomy insertion, balloon ureteroplasty, and antegrade DJ stent placement. Complete stone clearance and resolution of obstruction were ultimately achieved. CLINICAL DISCUSSION: This case highlights the complexity of managing large ureteric stones and the value of a multimodal endourological approach in challenging anatomy. The use of balloon ureteroplasty and antegrade stenting was critical in overcoming obstruction after failed wire passage. The case also reflects the importance of respecting patient autonomy while adhering to guideline-based management. CONCLUSION: A personalized, minimally invasive, kidney-sparing strategy can achieve successful outcomes in cases of giant distal ureteric stones, even when initial imaging suggests poor renal prognosis.

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