Steinstrasse

Plain abdominal radiograph shows multiple tiny stones (arrows) lined in the distal right ureter. The patient has had a recent extracorporeal lithotripsy.

Facts: Steinstrasse

• Steinstrasse is a German word, meaning "stone street" or "street of stones" first coined by the German pioneer of lithotripsy
• After lithotripsy, tiny stones line up in the ureter producing an appearance resembling a cobbled street on plain radiograph
• Steinstrasse can develop in 1 day to 3 months after stone fragmentation. It can develop after the first ESWL, or after several sessions.
• Incidence increases with stone size
• Most common location = distal ureter, followed up upper ureter
• It often passes by itself. 25% of patients, however, may experience obstruction at the ureteral level. If obstructed, percutaneous drainage or ureteral stent placement may be needed to manage ureteral obstruction until the fragments become dislodged and pass

Imaging

• Steinstrasse best detected with plain radiography
• Ultrasound is the most appropriate imaging mean to detect associated obstruction (hydronephrosis)

References:

1. Zagoria RJ. Genitourinary Radiology The Requisites, 2nd edition.

2. Sayed MA, El-Taher AM, Aboul-Ella HA, Shaker SE. Steinstrasse after extracorporeal shockwave lithotripsy: aetiology, prevention and management. BJUI 2001; 88:675-678.