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Introduction: Urinary stones are an important cause of morbidity in the US. More than 500,000 people are affected yearly, with a female gender prevalence and an age group ranging from 30 to 50 years old. Urinary tract stones are usually diagnosed in the emergency department where the symptomatic patient is admitted due to renal colic, a common symptom of ureterolithiasis. It is also true that ureteral stones can be silent for many months, leading to nephrectomy. Case Report: 69-years-old female patient, known with primary hypertension and chronic ischemic heart disease, under treatment with metoprolol, perindopril-indapamin and lercadipin; presented to the urology clinic ER complaining of colicky pain on the right side. She also had fever, shivering, nausea, vomiting and dysuria. At presentation the analyses were in normal range and uroculture was negative. The patient medical history reveals an increased cholesterol level, increased ESR, increased urea and a eGFR of 71.39 ml/min. From her surgical history emerged that she had a laparoscopic cholecystectomy. The Computed Tomography (CT scan) revealed a normal left kidney and an atrophic right one, with a decreased parenchymatous index (6mm) and pelvic hypotonia at the level of the caliceal groups, without kidney stones. In the right ureter, the CT showed a voluminous radiopaque mass measuring 48x12mm. Abdominal aortic calcifications were also noted. After repeated analyses, the eGFR was 81.34 ml/min, the ESR was 55ml/h, the cholesterol level was high and the urine culture tested positive for E. Coli, treated with antibiotics. Due to lack of symptoms, the patient developed a large calculus in the right ureter, which caused a hydroureter and a subsequent atrophization of the right kidney. The patient was referred to the surgeon for a nephrectomy. Discussions : The peculiarity of this case is that a large stone went unnoticed for years because the patient did not develop any symptoms. This led the patient to the operating room for a laparoscopic nephrectomy. The reason behind this surgical decision was to avoid recurrent UTIs, which could have exposed the patient to sepsis. Conclusions: Asymptomaticity was deleterious for this patient as it laid the foundations for the development of a silent change in the kidney structure, narrowing treatment options to surgery alone. It is possible to say that the nephrectomy could have been avoided if the stone had been caught earlier by being symptomatic. After surgery the patient was discharged in good conditions. [ABSTRACT FROM AUTHOR]