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Chief Complaint: 52-year-old male with abdominal pain andnausea.  

History: The patient was woken up by abdominal pain located inhis right lower quadrant, in the right groin and radiating into hisright testicle. He was transported to the hospital. He reports thathis pain is a “10” on a 1 to 10 scale. He is nauseated but has notvomited. The patient is normal weight and otherwise healthy. Uponpalpation his abdomen is soft with mild tenderness in the rightlower quadrant. Following the discovery of blood in his urine he isdiagnosed with a ureteral obstruction, a computed tomography scanshows a calcified stone in the right ureter at the ureterovesicaljunction.

Guiding Questions

1. The ureterovesical junction (where the ureter passes throughthe wall of the bladder) is a common site for kidney stones tobecome impacted. Can you propose two additional sites within theureter where kidney stones are likely to become impacted based onthe anatomy of the ureters?

2. This patient was advised toincrease his water intake to prevent subsequent kidney stones. Whywould an increased fluid intake lower his chances for a repeatincident?

3. Assume that the kidney stone inquestion has reached the bladder. What is the pathway of exit forthis stone (i.e. what anatomic structures must the stone still passthrough)? Based on the anatomy of those structures, do you predictthis to be difficult or easy? Defend your answer.

4. Propose a possible treatment forthe patient in this case study. How does this treatment improveconditions for the patient? Are these improvements seen at thecellular, tissue, organ or systemic level?