Factors predicting the spontaneous passage of a ureteric calculus of ⩽10 mm

Abstract

ObjectiveTo evaluate the outcome of the expectant management of ureteric stones and to determine the factors predictive of the spontaneous passage of stones. Patients and methodsWe retrospectively reviewed the medical records of patients who had ureteric stones of ⩽10mm and who were treated conservatively at our institutions during the period 2008–2013. The stone-passage rate and time, and different clinical, laboratory and radiological variables, were analysed. ResultsIn all, 163 patients with ureteric stones were enrolled in the study, of whom 127 (77.9%) passed their stones spontaneously, with a mean (SD) passage time of 24.0 (8.09)days. The cumulative stone-passage rate was 1.6%, 15%, 41.7%, 72.4%, 89.8% and 98.4% at 7, 14, 21, 28, 35 and 42days from the first presentation, respectively. Patients with a high pain-scale score, stones of ⩽5mm, a lower ureteric stone, a high white blood cell count and those with absent computed tomography (CT) findings of perinephric fat stranding (PFS) and tissue-rim sign (TRS) had a higher likelihood of spontaneous stone passage. Patients with stones of ⩽5mm, stones in the lower ureter and those with no PFS had a shorter spontaneous passage time. In a multivariate analysis the absence of PFS and TRS were the only significant predictors for spontaneous stone passage (P<0.001 and 0.002, respectively). ConclusionsThe spontaneous ureteric stone-passage rate and time varies with different factors. The absence of CT findings of PFS and TRS are significant predictors for stone passage, and should be considered when choosing the expectant management.