IS case 513: Steinstrasse

Alok Bhatt, MD

University of Rochester


Imaging Sciences URMC 2010
Publication Date: 2010-09-10

History

Patient is a 52-year-old female with history of renal calculi, now status post left-sided extracorporeal shockwave lithotripsy.

Findings

Oblique view of the abdomen shows multiple small opacifications in a linear fashion along the left ureter.

Diagnosis

Steinstrasse

Discussion

Many renal and ureteral calculi are treated with extracorporeal shock-wave lithotripsy. After the procedure, the broken fragments usually pass spontaneously down the ureter and into the bladder. Occasionally, these fragments do not pass, and line up within the ureter; this is called "steinstrasse" formation, German for "street of stones." Due to the inability of the normal ureteral orifice to allow passage of small fragments, most steinstrassen occur at the distal ureter. Previous surgery or inflammation may cause steinstrassen to form at the proximal ureter. A stone greater than 2 cm in diameter is at risk for steinstrasse formation. Most steinstrassen will spontaneously pass within days to weeks without any consequence. Those that continue to cause ureteral obstruction may need further intervention such as ureteroscopy or even percutaneous nephrostomy if symptoms are severe.

References

  1. Fedullo LM, Pollack HM, Banner MP, Amendola MA, Van Arsdalen KN. The development of steinstrassen after ESWL: frequency, natural history, and radiologic management. AJR Am J Roentgenol. 1988 Dec;151(6):1145-7. PMID: 3263767

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