Spontaneous Passage of a 5 cm Ureteric Calculus: A Case Report and Review of the Literature

Ureteric calculi larger than 10 mm rarely pass spontaneously, and current guidelines recommend active intervention beyond this threshold. We report a 62-year-old woman who presented with obstructive pyelonephritis secondary to a 5.4 cm by 0.8 cm proximal ureteric calculus. Following antibiotic therapy and a staged surgical plan, the stone migrated distally over several months and was spontaneously passed 92 days after initial presentation, after only two weeks of alpha-blocker therapy. To our knowledge, this is the first reported spontaneous passage of a ureteric calculus exceeding 5 cm, challenging existing assumptions regarding stone diameter and passage likelihood.