VESICOURETERIC JUNCTION CALCULUS MASQUERADING AS BLADDER OUTLET OBSTRUCTION: MEDICAL EXPULSION THERAPY IN ATYPICAL PRESENTATIONS

Dr. Abhay Garg, Dr. Madhur Anand, Dr. Sonu K. Plash, Dr. Shashank Patil, *Dr. Sanjay P. Dhangar, Dr. Aman Jasuja, Dr. Ajay Lakhe

Background: Lower urinary tract symptoms (LUTS) in adult males are conventionally attributed to benign prostatic hyperplasia or bladder outlet obstruction (BOO), whereas ureteric calculi classically present with renal colic. Distal and vesicoureteric junction (VUJ) calculi can, however, present predominantly with irritative and obstructive voiding symptoms rather than typical colic, creating a recognised diagnostic pitfall. Methods: We conducted a retrospective, single-centre case series of 15 male patients (age range 18–40 years) who presented with LUTS and obstructive uroflowmetry and were subsequently found to have a VUJ calculus (4.4–6.5 mm) on renal tract ultrasonography. All patients were evaluated with history, digital rectal examination, urinalysis, urine culture, renal function tests, uroflowmetry and ultrasonography of the kidneys, ureters and bladder. All were managed conservatively with medical expulsive therapy (MET) tamsulosin 0.4 mg once daily, oral diclofenac, and oral hydration of 2–3 L/day and followed up with repeat uroflowmetry and ultrasonography. Results: The mean patient age was approximately 29 years and mean stone size was approximately 5.5 mm (range 4.4–6.5 mm); nine calculi were left-sided and six right-sided. All 15 patients demonstrated spontaneous stone passage confirmed on repeat ultrasonography, complete resolution of voiding symptoms and flank discomfort, and normalisation of uroflowmetric parameters (restoration of a bell-shaped curve) at follow-up, with no complications. The overall success rate of MET in this cohort was 100%. Conclusion: VUJ calculi should be actively excluded by renal tract ultrasonography in young men presenting with LUTS and obstructive uroflowmetry, particularly when prostate volume is disproportionately small relative to the degree of urodynamic impairment. Medical expulsive therapy is a safe and effective first-line strategy for small VUJ calculi presenting in this manner.