What is stone street
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Stone Street
Stone Street most commonly refers to a historic street in the Financial District of Lower Manhattan, New York City.
Key Facts:
- One of the oldest streets in NYC, first paved in 1658 — making it the first paved street in New Amsterdam (the Dutch colonial settlement that became New York City).
- It runs as a short, cobblestone street in two sections near Broad Street and Coenties Alley.
- The original 17th-century paving stones are still there — buried about six feet underground beneath the current surface.
- Today it's a pedestrian-only cobblestone street lined with restaurants, bars, and outdoor seating, and is known for lively street festivals.
- It is designated the Stone Street Historic District, and its surroundings include some of the oldest surviving commercial architecture in Manhattan (mostly early 19th-century buildings).
It's a popular spot for after-work drinks and outdoor dining, sitting in sharp contrast to the surrounding modern skyscrapers of the Financial District.
There are also streets named Stone Street in other cities (e.g., London, various U.S. towns), but the Manhattan one is by far the most notable. Were you asking about a specific Stone Street somewhere else?
Steinstresse in urology
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Steinstrasse urology ureter stone
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Steinstrasse (Stone Street) in Urology
Steinstrasse is a German word meaning "stone street." In urology, it refers to the accumulation and linear alignment of stone fragments along the ureter after Extracorporeal Shock Wave Lithotripsy (ESWL), forming a "street" of gravel that can obstruct the ureter.
How It Occurs
After ESWL fragments a large renal or ureteral calculus, the resulting debris must pass down the ureter. When the fragment burden is large, the pieces can accumulate in a column — typically in the distal ureter — and cause obstruction rather than passing freely.
- Incidence is higher with larger stone burdens (reported ~23% with SWL monotherapy for larger renal stones)
- Stone burden is the main predictor of postoperative steinstrasse
Clinical Presentation
- Asymptomatic — incidental finding on post-ESWL imaging (KUB radiograph or ultrasound)
- Symptomatic — renal colic, severe flank pain, fever (suggesting infection/urosepsis), or hydronephrosis
Radiological Appearance
The image below shows a classic case of steinstrasse:
(A) Pre-ESWL: stone visible in the left renal pelvis. (B) Post-ESWL: the pelvic stone has fragmented; note the string of stone fragments aligned throughout the length of the ureter, with a double-J stent in situ to facilitate passage. — Comprehensive Clinical Nephrology, 7th Ed.
Management
| Scenario | Management |
|---|---|
| Asymptomatic | Serial KUB radiographs + ultrasonography; encourage ambulation and fluid intake |
| Severe pain or fever | Active intervention required |
| Ureteral obstruction | Percutaneous nephrostomy drainage — decompresses the collecting system, coaptation of ureteral walls encourages fragment passage |
| Refractory/non-resolving | Retrograde ureteroscopy to retrieve the lead fragment(s) — usually 1–2 large fragments are obstructing, and their removal resolves the column |
"It is only in the rare patient that steinstrasse does not resolve with the procedures outlined; such cases require retrograde endoscopic manipulations to relieve the obstructed stone fragments." — Smith and Tanagho's General Urology, 19th Ed.
Prevention
A double-J ureteral stent placed before ESWL can reduce the risk of steinstrasse by providing a scaffold along which fragments pass more easily. However, pre-stenting is not routine in all cases (the benefit vs. risk of stent placement is weighed individually).
Other complications to be aware of alongside steinstrasse post-ESWL include: sepsis, ureteral stricture, perinephric hematoma, and ureteral injury.
Sources: Comprehensive Clinical Nephrology, 7th Ed. | Smith and Tanagho's General Urology, 19th Ed. | Campbell-Walsh-Wein Urology
When to remove the stent
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ureteral stent removal timing ESWL
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Based on the context of the previous question (stent placed before ESWL to prevent/manage steinstrasse), here is a comprehensive answer on when to remove the double-J ureteral stent:
When to Remove a Ureteral Stent (in the Context of ESWL/Steinstrasse)
After ESWL (Pre-placed stent to prevent steinstrasse)
The stent is removed once the stone fragments have passed and the patient is confirmed stone-free on imaging (KUB radiograph ± ultrasound). There is no fixed universal timeline — it is guided by:
| Criterion | Action |
|---|---|
| Stone-free on imaging (KUB/ultrasound) | Remove stent — typically within a few weeks post-ESWL |
| Fragments still present but asymptomatic | Continue with serial imaging; defer removal |
| Symptomatic obstruction or fever | Intervene first (nephrostomy or ureteroscopy), then remove stent when resolved |
After Ureteroscopy (URS) for Stone
The stent placed routinely post-URS is typically removed at 1–2 weeks via cystoscopy (or by an attached string if left), once ureteral edema has settled and the patient is stone-free.
After Ureteral Injury / Perforation
A stent placed after ureteral injury or perforation (e.g., during endoscopy) should remain for approximately 4 weeks, followed by imaging (retrograde pyelogram or CT urography) before removal to confirm adequate healing and drainage. — Campbell-Walsh-Wein Urology
After Endopyelotomy (UPJ repair)
The stent is left for 6 weeks to allow the incised ureteropelvic junction to heal. — Smith and Tanagho's General Urology, 19th Ed.
Key Principle: Don't Leave Stents in Too Long
"When the stent is left in place for prolonged periods, the likelihood of incrustations, poor drainage, and difficult extraction is increased." — Smith and Tanagho's General Urology, 19th Ed.
- Metal stents can remain for up to 1 year
- Standard polymer double-J stents should generally be changed or removed within 3–6 months to avoid encrustation and obstruction
- Patients must always be informed a stent has been placed and given a clear follow-up plan for removal
Summary for steinstrasse context specifically: Remove the stent once stone fragments have cleared on imaging — confirm with KUB ± renal ultrasound, typically a few weeks after ESWL. If steinstrasse persists, treat the obstruction first, then remove the stent once resolution is confirmed.
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