Contemporary Practice Patterns in the Management of Acute Obstructing Ureteral Stones

Abstract

To elucidate current practice patterns among Endourological Society members for acutely obstructing ureteral stones necessitating intervention. A practice pattern survey was sent to members of the Endourological Society using Survey Monkey. The following question stem was given: "Patient presents to the ER with acute renal colic and intractable pain, no signs of infection, i.e. afebrile and no pyuria. Stone is obstructing, and causing intractable pain; thus observation or medical expulsive therapy is not appropriate." A follow-up stem was provided for specific scenarios: "Calculus measuring x mm at x location. What is your preferred management option?" The options given for immediate management included shockwave lithotripsy (SWL), ureteroscopy (URS), stent placement, or percutaneous management. Four hundred and sixteen complete responses of approximately 2000 were received. There was a significant difference in management choice based on stone location (P<0.001) and stone size (P<0.001). URS was the predominant modality used for urgent treatment of acute proximal ureteral stones from 5, 10, and 15 mm except for calculi of 20 mm, where the preference was for percutaneous management. Immediate URS was the preferred choice for all distal and midureteral stones, regardless of size. The use of stents vs percutaneous nephrostomy drainage was similar (18% vs 16%, respectively) for proximally obstructing calculi, while stent insertion was preferred over nephrostomy for mid and distal stones. Current practice patterns among endourologists indicate a strong preference for immediate URS management over stent placement or SWL for acutely obstructing ureteral calculi. Not surprisingly, 20-mm stones in the proximal ureter had percutaneous management.