Steinstrasse

• Post-extracorporeal lithotripsy may result in multiple stone fragments lining up in the ureter
• Steinstrasse literally means “stone street” or “street of stones” coined by the German pioneers of lithotripsy
• The goal of lithotripsy is to fragment stones small enough to pass spontaneously into the bladder
• Many patients have transient hematuria and sometimes colic as the stones pass

• Symptomatic steinstrasse typically occurs in the distal ureter

• Sometimes, the fragments themselves may cause obstruction

• Either because of a single large fragment (>5mm), or
• Accumulation of multiple small fragments

• Imaging findings

• Post-lithotripsy, the stones line up in the ureter producing what was once though to resemble a cobbled street
• Conventional radiography is usually the modality necessary to display Steinstrasse calculi
• Identification of post-lithotripsy hydronephrosis is usually done with sonograms

• Urinary tract obstruction has been reported in up to 31 % of patients who underwent lithotripsy
• The incidence of obstruction has been related to the size of the original stone (the larger, the more likely), the number of stones and their location (more likely with stones in the renal pelvis)
• Most of these small calculi can be treated conservatively but some may require intervention if obstruction persists

Steinstrasse. Multiple small calculi are lined up in the distal left ureter (white oval)
after extracorporeal shockwave lithotripsy had been performed in this patient. A ureteral stent had
been placed (black arrow) as a precautionary measure.
For the same photo without the arrows, click here