Urolithiasis with pre-vesical stone
Left flank pain.
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Plain film shows a pre-vesical stone on the left.
13 minutes after infusion of contrast medium there is contrast of the right pyelon and in the bladder, but yet no contrast of the left pyelon. There is also contrast outlining the left kidney, whereas it has already cleared from the right (delayed nephrogram).
Two hours after infusion you can appreciate a distension of the left ureter and a hydronephrosis of the left pyelon.
This examination demonstrates the typical IVP features of collecting system dilatation and a delayed nephrogram secondary to a distal obstructing calculus. In this case, the calculus is well seen radiographically.
Treatment depends on the location of the stone, composition and size.
Irrespective of stone composition, patients who present with renal colic require assessment. Approximately 90% of stones less than 4mm are likely to pass down the ureter and into the bladder, and thus often require no more than analgesia and hydration 1