Spontaneous steinstrasse: A case report and literature review

Spontaneous steinstrasse without prior lithotripsy is rare. A 45-year-old male with history of urinary bilharziasis presented with bilateral renal colic. CT scan revealed multiple bilateral renal calculi and a left pelvic ureteral stone cluster measuring 22 × 44 mm. Open surgery retrieved 207 stones from left ureter and 34 from left kidney, requiring ureteral reimplantation. Right ureterolithotomy with resection of bilharzial stenosis was performed. This case is unique for the unprecedented number of stones retrieved and the identification of urinary bilharziasis as underlying etiology, never previously reported. Open surgery remains valuable when endoscopic options are unavailable or complex reconstruction is needed.