In a patient with renal calculi, radiating pain to the groin most strongly suggests that the stone has progressed to which segment of the ureter?

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Pain from a ureteral stone follows the path of the ureter and the spinal nerves that supply it. The upper portion of the ureter and the renal pelvis typically produce flank or back pain, sometimes with nausea. As the stone moves downstream toward the lower ureter, the referred pain shifts toward the groin, and can extend to the scrotum in men or the labia in women. The distal ureter, near the bladder, is where sensation is most commonly referred to the groin region.

So when the pain radiates strongly to the groin, it most strongly points to involvement of the lower third of the ureter, near the vesicoureteral junction. In contrast, bladder-related pain tends to be suprapubic and may not radiate to the groin, and stones higher up in the ureter or in the renal pelvis typically produce flank/back pain rather than groin radiation.