A retrospective study on the management of ureteric stones following presentation to the emergency department in the University Hospitals Sussex Trust East from November 2020 to November 2021

Abstract

Objective: To ascertain which patient demographic, clinical and stone-specific factors were significant when predicting intervention for ureteric stones and determine the proportion of patients with smaller, more distally located stones requiring intervention to establish whether follow-up imaging was indicated to confirm stone passage. Subjects/patients and methods: This is a retrospective review of 227 patients presenting with ureteric stones on non-contrast computerised tomography (NCCT) between November 2020 and November 2021. Eleven different clinical, demographic and imaging-related factors were recorded, and multivariate logistical regression was used to determine which factors were significant when predicting intervention. Results: A total of 53 patients (23.3%) underwent some form of intervention with only stone size ( p < 0.001) and stone location ( p < 0.001) significant in predicting treatment. Only 4.17% of patients with a ⩽ 4 mm distally located stone required intervention. These patients either had raised inflammatory markers or significant pain. Conclusion: Given that 95.83% of patients with ⩽ 4 mm distal ureteric calculi passed their stone spontaneously, a patient-initiated follow-up (PIFU) could be implemented to replace a follow-up NCCT. Based on this dataset, the application of PIFU could have prevented additional radiation exposure of 1.5–3 mSv/patient and excess financial cost of approximately £7000 to services. Level of Evidence: Level 3