Spontaneous steinstrasse-a rare clinical case report

Abstract

The term "steinstrasse" was first introduced by Egbert Schmiedt and Christian Chaussy in the 1980s to describe stone accumulation in the ureter following extracorporeal shock wave lithotripsy. Clinically, patients present with lumbar pain, nausea/vomiting, and lower urinary track symptoms. Severe cases may lead to obstruction or sepsis. It is observed mostly in patients who have undergone extracorporeal shock wave lithotripsy, but in rare cases it can occur spontaneously. Spontaneous formation of steinstrasse is a rare phenomenon with only several cases reported in literature so far and for that reason there are no standard protocols for the management of such patients. Various factors need to be taken into account when choosing the optimal therapeutic strategy. We present a rare clinical case of idiopathic spontaneously occurring steinstrasse. We will discuss the clinical course, the diagnostic algorithm, and the therapeutic approach.

Figure 1

(a) Abdominal ultrasound demonstrating right kidney with evidence of grade 2–3 hydronephrosis. (b) Right kidney right-sided ureterohydronephrosis on CT scan.

Figure 2

CT scan reconstruction—cluster of stones sizes, respectively, 5.2 mm, 3.2 mm, 2.8 mm—13.4 mm combined in the right distal ureter.

Figure 3

CT scan of steinstrasse formed in the right distal ureter.