Available now! Telegram Research 2025 โ the year's key insights 
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๐ชจ ESWL for small stones, PCNL for big bones
Small stones โค2โฏcm โ ESWL Larger โ PCNL.
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A patient present with pain and tenderness in the left iliac fossa. USG shows a 2 cm stone in the renal pelvis without any hydronephrosis. Most appropriate management:
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Ureteric stone ๐ชจ climbs the nerve ladder ๐ช โ hits Genitofemoral ๐ฏ โ groin/scrotum pain ๐ฃ.
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Ureteric colic pain is referred along this nerve because the ureter shares visceral afferent fibers with L1โL2 spinal segments.
Hence, stone in the ureter causes loin-to-groin pain radiating along genitofemoral distribution.
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Referred pain from ureteric colic is felt in the groin due to involvement of the following nerve:
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Proteus species are urease-producing bacteria.
Urease splits urea โ ammonia โ raises urine pH โ alkaline urine.
Alkaline urine + cloudiness with pus cells indicates urinary tract infection with Proteus.
This environment also favors struvite (triple phosphate) stone formation.
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A patient with alkaline urine which is cloudy with plenty of pus cells is suffering from infection with:
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