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J Surg Case Rep. 2018 Oct 8;2018(10):rjy252. doi: 10.1093/jscr/rjy252. eCollection 2018 Oct.

Spontaneous resolution of a spontaneous steinstrasse: a case report.

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Luton and Dunstable Hospital, Lewsey Road, Luton, UK.
Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, St Mary's Hospital, London, UK.
North Middlesex Hospital, Sterling Way, London N18 1QX, UK.


A 63-year-old man presented with a 4-day history of right sided loin-to-groin pain. Computed tomography imaging revealed a 22 mm by 7 mm volume of contiguous ureteric calculi at the right vesicoureteric junction. Spontaneous steinstrasse was diagnosed with no recent history of extracorporeal shock wave lithotripsy (ESWL) or other urological intervention to the right kidney. Metabolic testing was negative. An initial plan was made for urgent primary ureteroscopy and lithotripsy, however, the patient spontaneously passed 20-25 calculi at home whilst awaiting his operation date. He was reviewed in clinic and his symptoms had resolved. His ureteroscopy was cancelled. This case represents an example of spontaneous steinstrasse with no identified causative factors, a rare occurrence on which little literature is available presenting a management dilemma to the treating clinician. The case described resolved prior to intervention prompting us to suggest that spontaneous steinstrasse can be initially managed conservatively, as in ESWL-associated steinstrasse.

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