Spontaneous Passage Research Articles

680 A Virtual Stone Clinic Using an Electronic Database Streamlines the Patient Pathway

IntroductionWe have set up an electronic database to record patients requiring follow-up, which is reviewed in a virtual stone clinic (VSC). A consultant led VSC is held weekly to review the database and follow-up patients virtually.MethodAnalysis of patients added over a 15-month period was performed. Outcomes included spontaneous stone passage rates, intervention rates and time from initial imaging to VSC outcomes.Results615 patients with a median age of 48 years were analysed. Emergency referrals to urology accounted for 85.9% of data. VSC review occurred a median of 5 days after initial imaging. Majority of stones were lower ureteric (64.6%), 28.1% upper ureteric and 7.2% renal stones. Follow up data was available for 557 patients (90.6%). 73.6% of patients passed stones spontaneously.Median time from investigation to imaging was 21 days. 372 patients were discharged following VSC review. 111 patients were listed for surgical intervention. Median time to intervention was 21 days for ESWL, 62 days for ureteroscopy and 202 days for PCNL.ConclusionsVSC leads to shorter waiting times for follow-up imaging and interventions in patients with renal stone disease. This is especially evident in the current Covid-19 pandemic, resulting in higher quality of care.

Complications of common bile duct stones: A risk factors analysis

BackgroundThe latest guidelines recommended that common bile duct stones (CBDSs) should be removed, preferably endoscopically, regardless of the presence of symptoms or complications. However, the removal of CBDSs may not be feasible in very old patients or those with co-morbidities. In these cases, it is important to understand the risk factors for the development of CBDSs-related complications to decide whether or not to treat high-risk patients. Herein, we aimed to identify the risk factors for the development of complications after the diagnosis of CBDSs. MethodsThe medical records of patients with CBDSs between October 2005 and September 2019 were retrospectively analyzed. All patients with radiologically-diagnosed CBDSs, including those who received treatment and those who did not, were analyzed. ResultsA total of 634 patients were included and 95 (15.0%) patients had CBDS-related complications during the mean follow-up period of 32.6 months. Forty-four (6.9%) high-risk patients remained asymptomatic and did not receive treatment during the follow-up period. In multivariate analyses, size of CBDSs ≥ 5 mm and no treatment within 30 days were independent risk factors for the development of complications. The spontaneous passage of CBDSs was proved radiologically in 9 out of 81 (11.1%) patients within 30 days. ConclusionsIt is recommended treating CBDSs within 30 days from the diagnosis, even in high-risk patients, especially if the size is larger than 5 mm.

Novel Use of a Modified Triangular Prismatic Double-J Stent for 2- to 3-cm Renal Stones after One-Stage Retrograde Intrarenal Surgery

Objectives: To initially evaluate the outcomes of the modified triangular prismatic double-J (DJ) stent in the management of 2- to 3-cm renal stones after one-stage retrograde intrarenal surgery (RIRS). Methods: Patients with 2- to 3-cm renal stones who underwent one-stage RIRS with indwelling DJ stents were retrospectively evaluated. Eighty-eight patients who were placed the triangular prismatic DJ stents and 64 patients who received standard DJ stents were randomly included. The clinical characteristics and intraoperative and postoperative outcomes of the 2 groups were compared and analyzed. Results: The 2 groups had similar baseline characteristics. The urinary symptom score and pain score did not differ between groups (p > 0.05). The residual fragments of the 2 groups were similar 1 day after operation (p = 0.134). There was no significant difference in residual fragments in the lower calyx between groups at the time of stent removal (p = 0.834). The patients in the modified group had better spontaneous passage of residual fragments in the nonlower calyx than those in the standard group during the 2 weeks with the stents (p = 0.005). Fewer patients in the modified group had residual fragments (>4 mm) in the nonlower calyx (p = 0.026) and ureter (p = 0.010) than the patients with standard stents at the time of stent removal. Conclusion: The indwelling triangular prismatic DJ stent is a safe and efficient treatment method. Patients with these stents had better spontaneous residual fragment passage than those with the standard DJ stents.

Automated radiomic analysis of CT images to predict likelihood of spontaneous passage of symptomatic renal stones.

To evaluate the ability of a semi-automated radiomic analysis software in predicting the likelihood of spontaneous passage of urinary stones compared with manual measurements. Symptomatic patients visiting the emergency department with suspected stones in either kidney or ureters who underwent a CT scan were included. Patients were followed for up to 6 months for the outcome of a trial of passage. Maximum stone diameters in axial and coronal images were measured manually. Stone length, width, height, max diameter, volume, the mean and standard deviation of the Hounsfield units, and morphologic features were also measured using automated radiomic analysis software. Multivariate models were developed using these data to predict subsequent spontaneous stone passage, with results expressed as the area under a receiver operating curve (AUC). One hundred eighty-four patients (69 females) with a median age of 56 years were included. Spontaneous stone passage occurred in 114 patients (62%). Univariate analysis demonstrated an AUC of 0.83 and 0.82 for the maximum stone diameter determined manually in the axial and coronal planes, respectively. Multivariate models demonstrated an AUC of 0.82 for a model including manual measurement of maximum stone diameter in axial and coronal planes. The same AUC was found for a model including automatic measurement of maximum height and diameter of the stone. Further addition of morphological parameters measured automatically did not increase AUC beyond 0.83. The semi-automated radiomic analysis of urinary stones shows similar accuracy compared with manual measurements for predicting urinary stone passage. Further studies are needed to predict clinical impacts of reporting the likelihood of urinary stone passage and improving inter-observer variation using automatic radiomic analysis software.

Serum Amylase Levels is a Predictor for Negative Endoscopic Retrograde Cholangiopancreatography for Suspected Common Bile Duct Stones.

Negative endoscopic retrograde cholangiopancreatography (ERCP) for suspected common bile duct stones (CBDS) may be associated with significant morbidity and should be avoided. Between 2010 and 2018, 85 patients who have undergone negative ERCP for suspected CBDS were retrospectively evaluated and compared with 318 patients with positive findings. Predictors for negative ERCP were assessed. Patients with negative ERCP were younger; had increased levels of serum amylase, alanine transaminase, and lactate dehydrogenase; and increased hemoglobin. Even though preprocedure computed tomography (CT) or ultrasonography demonstrating CBDS were highly predictive of positive findings on ERCP, of the 212 patients with CBDS on computed tomography or ultrasonography, 17 (8%) eventually had a negative ERCP, suggesting spontaneous stone passage. An increased serum amylase level was the only predictor for negative ERCP in multivariate analysis, including in patients with preprocedure CBDS on imaging. The data suggest that assessing serum amylase may assist in avoiding unnecessary examinations.

Ureteral Stones: Spontaneous Passage or Urologic Intervention?

Patients with acute ureteral stones can be managed either by a trial of spontaneous passage or by early urologic intervention (usually ureteroscopy

Analgesic and Opioid Use for Patients Discharged from the Emergency Department with Ureteral Stones.

Objective: The aim of this study was to describe and characterize the analgesic and opioid use for patients discharged from the emergency department (ED) with renal colic due to ureteral stone. Methods: This is a secondary analysis of a multicenter prospective trial of ED patients diagnosed by CT scan as having a symptomatic ureteral stone <9 mm in diameter. Participants were contacted after randomization on days 2, 7, 15, 20, and 29 and reported opioid and nonopioid analgesic use and stone passage. CT scan was repeated on day 29 to 36 to confirm passage. Results: Of 403 participants, 314 (77.9%) took an analgesic after discharge and 199 (49.4%) took opioids. Opioids were more commonly used by younger patients (p = 0.04) and those with a family history of stones (p = 0.003). Stone size and tamsulosin use were not associated with analgesic utilization. Shorter time to passage and more distal stone location were associated with less analgesic and opioid use. For those who did not expel a stone, 55.0% took opioids at any time, and for those who did expel a stone, 31.9% took opioids before the stone was expelled and 15.7% took opioids at any time after the stone was expelled. Conclusions: Factors associated with increased use of analgesics in patients discharged from the ED include a longer time to stone passage, no spontaneous passage, and proximal position of the stone in the ureter. Some patients continued to use analgesics after the stone had passed, but most stopped using analgesics by day 29. The study has been registered at https://clinicaltrials.gov (NCT00382265).

Modern surgical strategies in the management of complex ureteral strictures.

The purpose of this article is to outline the various therapeutic options of ureteral strictures. Ureteral strictures with consecutive hydronephrosis can be due to endourological and surgical procedures, inflammatory processes, radiation therapy as well as spontaneous passage of ureteral calculi. When planning surgical correction, stricture length, anatomical location as well as patients' characteristics like age, comorbidities and previous treatment in the peritoneal cavity, retroperitoneum or pelvis should be taken into consideration. Treatment options include not only surgical reconstruction techniques like simple stricture excision, end-to-end anastomosis, ureterolysis with omental wrapping, ureteroneoimplantation, renal autotransplantation and ureter-ileum replacement, but also minimally invasive procedures such as self-expandable thermostents and pyelovesical bypass prosthesis. Various therapeutic options can be offered in the treatment of ureteral strictures, potentially leading to long-term success rate of more than 90% and a rate of significant complications < 5%.

Spontaneous ureteral stone passage: a novel and comprehensive nomogram

Background Ureteral stones pose a high economic and medical burden among Emergency Department (ED) admissions. Management strategies vary from expectant therapy to surgical interventions. Since predictors of ureteral spontaneous stone passage (SSP) are still not well understood, we sought to create a novel nomogram to guide management decisions. Methods Charts were retrospectively reviewed for patients who presented to our institution's ED with non-febrile renal colic and received a radiological diagnosis of ureteral stone ≤10 mm. Demographic, clinical, laboratory, and non-contrast CT data were collected. This novel nomogram incorporates the serum neutrophil-to-lymphocyte ratio (NLR) as a potential predictor of SSP. The model was derived from a multivariate logistic regression and was validated on a different cohort. A receiver operator characteristic (ROC) curve was constructed and the area under the curve (AUC) was computed. Results A total of 1186 patients presented to our ED between January 2010 and October 2018. We randomly divided our population into a derivation and validation cohort in one to five ratio. A stone size ≥ 7 mm was the strongest predictor of SSP failure; OR=9.47; 95%CI (6.03-14.88). Similarly, a NLR ≥ 3.14 had 2.17; (1.58-2.98) the odds of retained stone. SSP failure was also correlated with proximal position, severe hydronephrosis, and leukocyte esterase ≥ 75, p=0.02, p=0.05, and p=0.006, respectively. The model had an AUC of 0.804 (0.776-0.832). The nomogram was also used to compute the risk of SSP failure (AUC 0.769 (0.709 - 0.829). Conclusions Our novel nomogram can be used as a predictor for SSP and can be used clinically in decision making.

This Month in Adult Urology

This Month in Adult Urology

Vesicourachal diverticulum with calculus in a recurrent stone former: A rare entity

The urachus is a tubular embryonic structure connecting the allantois at the umbilicus to the bladder. It gets obliterated and remains as median umbilical ligament. Partial or complete failure of this process results in urachal anomalies. We are reporting a rare case of 54 year male patient presenting with obstructive lower urinary tract symptoms and history of spontaneous passage of stones in urine and on evaluation found to have vesicourachal diverticulum with calculus in it.

Radiological Study on the Anatomical Site and Size of Ureteric Calculi: A Retrospective Study

ntroduction: Ureteric stones are said to lodge most commonly at the narrowest anatomical areas of the ureter. The site of pain depends on the location of the calculi. Spontaneous passage of ureteric stones is influenced by size, location and laterality of the stones. Aim: To investigate the size and location of ureteric stones. Materials and Methods: This was a retrospective study of 72 patients in whom urinary stones were diagnosed by computed tomography between January 2018 and July 2019. The size of the ureteric stones was measured by its maximal width on Computed Tomography (CT) and location of the stones was also determined. The diameter of both the ureters were ascertained at the widest portion. Statistical analysis was performed using SPSS version 23. Descriptive data was presented as percentage and mean while comparative analysis was done using Student’s t-test. Results: The average patient age was 41±12.4 years (range, 17- 70 years) affecting 42 (58.33%) males and 30 females (41.77%). The ureteric stones were localized at the VUJ in 30 cases (41%), at the distal ureter in 11 (15%), at the level of external iliac vessel in 3 cases (5%), at the proximal part in 19 (27%) and at the PUJ in 9 cases (12%). Calculi were identified more often on the right ureter (44 cases, 61.2%) than the left (28 cases, 38.8%). The average diameter of the ureter on the right and left was 3.46 mm (range, 1.8-4.7 mm), and 3.33 mm (range, 2.1- 5.5 mm) respectively. There was no significant difference in the mean diameter of the ureteric stones of both the sides at the corresponding levels of the ureter. The smaller the stones, the closer to the VUJ were they located. Conclusion: This study provides an insight into the anatomy of the ureter and would be essential for selection of appropriate line of intervention and treatment modality.

Fungal ball obstructive uropathy in an elderly female with nil comorbidity: A case report and review of literature

Fungal balls in the upper urinary tract are a rare cause of obstructive uropathy. We describe a case of renal fungal ball in an immunocompetent lady with extreme of age and gender as risk factors. The patient presented with recurrent renal colic and complicated urinary tract infection. She had complete resolution of symptoms with spontaneous passage of fungal ball and systemic antifungal therapy.

Гендерні та вікові особливості мінерального складу сечових каменів у пацієнтів з сечокам’яною хворобою

The paper presents the results of studying the features of the mineral composition of urinary stones obtained after spontaneous passage, as well as the use of minimally invasive surgical techniques. Material and methods. The study involved 61 patient with urolithiasis, depending who were examined depending on the sex and age of the patients. Infrared spectroscopy in the spectral range of 4000-400 cm-1 was used as a method for assessing the mineral composition of the stone. The next stage of the study consisted of analyzing the occurrence of stones of various mineral types in groups of patients with different gender and age characteristics. Results and discussion. Infrared spectroscopy identified a wide range of chemical compounds in urinary stones, in which calcium oxalate in the form of monohydrate (vevelite) or dihydrate (vedelite), calcium phosphate in the form of hydroxylapatite and uric acid were most often identified. Calcium carbonate, aragonite, struvite, ammonium urate, and cystine were detected in single samples. 45 patients (73.77%) had a mixed composition of the stone, consisting of two or more mineral components. Depending on the prevailing component, which is more than 50% vol. the sample, urinary stones were classified into 3 mineral types: type 1 – calcium oxalate calculi, the prevailing component of which is calcium oxalate in the form of monohydrate (vevellite) or dihydrate (veddelite); Type 2 – calcium phosphate, in which more than 50% vol. represented by apatite, hydroxylapatite or fluorapatite; Type 3 – stones, the dominant substance of which is uric acid or uric acid dihydrate. Most of the urinary stone samples were represented by type 1 stones, which were significantly more often detected in males. The study of gender dependence in the prevalence of stones of types 2 and 3, corresponding to these minerals, was not identified. Type 1 urinary stones were observed in all age categories, with a predominance in patients aged 30-39 years (41.38%). The age distribution of stones of type 2 had similar characteristics, while the maximum number of patients with this type of stone was noted in the age range of 40-49 years (40%), followed by a decrease in this indicator in older age groups. The minimum number of cases of type 3 stone formation was registered among patients aged 30-39 years (8.33%). In the following age periods, the quantitative presence of this type of stones increased with a maximum value in the age range of 50-59 years (41.67%). Conclusion. The mineral composition of urinary stones has features, depending on the sex and age of patients. The formation of oxalate-calcium urinary stones is most characteristic of men, the peak incidence occurs at the age of 40-49 years. Gender features of the distribution of stones, the dominant components of which are calcium phosphate and uric acid were not detected. The frequency of detection of uric acid stones increases with age, the inverse relationship is characteristic of the age distribution of phosphate-calcium stones

Role of conservative management of stones.

Urinary tract stone disease is one of the most common pathologies of the modern era with a rising prevalence owing to incidentally detected renal stones from imaging for other reasons. Although there is consensus on active management of symptomatic and asymptomatic stones in high-risk patient groups, conservative management of stones is still controversial. We have reviewed the literature pertaining to conservative management of 3 groups of stones-asymptomatic calyceal stones, staghorn stones, and ureteric stones-and summarized the findings to provide guidance in the conservative management of stones. In the calyceal stone group, our review showed an average spontaneous stone passage rate of 18% (range, 8%-32%) and an average requirement for surgical intervention of 20% (range, 7%-40%), with 62% of patients remaining safely on surveillance over a mean time of 4 years. In the staghorn group, overall disease-specific mortality was noted to be 16% (range, 0%-30%) and chance of renal deterioration was 21% (range, 0%-34.5%), with a mean incidence of infection of 22%. In case of conservatively managed ureteric stones, the rate of spontaneous passage for stones smaller than 5 mm was 75%, compared with 62% for those larger than 5 mm. Based on the position in the ureter, spontaneous passage rates were 49%, 58%, and 68% for proximal, middle, and distal thirds, respectively. Conservative management may be recommended for asymptomatic patients and those who are deemed unfit for any procedures. However, careful patient selection and thorough counseling about the risks of conservative management could make it a suitable option for an appropriate subset of patients.

Which Patients Should Have Early Surgical Intervention for Acute Ureteral Colic?

Early surgical intervention is an attractive option for acute ureteral colic but existing evidence does not clarify which patients benefit. We compared treatment failure rates in patients receiving early intervention and patients offered spontaneous passage to identify subgroups that benefit from early intervention. We used administrative data and structured chart review to study consecutive patients attending 9 emergency departments in 2 Canadian provinces with confirmed 2.0 to 9.9 mm ureteral stones. We described patient, stone and treatment characteristics, and performed multivariable regression to identify factors associated with treatment failure, defined as intervention or hospitalization within 60 days. Our secondary outcome was emergency department revisit rate. Overall 1,168 of 3,081 patients underwent early intervention. Those with stones smaller than 5 mm experienced more treatment failures (31.5% vs 9.9%, difference 21.6%, 95% CI 16.9 to 21.2) and emergency department revisits (38.5% vs 19.7%, difference 18.8%, 95% CI 13.8 to 23.8) with early intervention than with spontaneous passage. Patients with stones 7.0 mm or larger experienced fewer treatment failures (34.7% vs 58.6%, risk difference 23.9%, 95% CI 11.3 to 36.6) and similar emergency department revisit rates with early intervention. Patients with 5.0 to 6.9 mm stones had fewer treatment failures with intervention (37.4% vs 55.5%, risk difference 18.1%, 95% CI 7.1 to 28.9) if stones were in the proximal or middle ureter. Early intervention improves outcomes for patients with large (greater than 7 mm) ureteral stones or 5 to 7 mm proximal or mid ureteral stones. Early intervention may increase morbidity for patients with stones smaller than 5 mm. These findings could help inform future guidelines.

The influence of stone size on spontaneous passage of common bile duct stones in patients with acute cholangitis: A retrospective cohort study

BackgroundThe common bile duct (CBD) stones passage in patients with cholangitis was unclear.This study aimed to evaluate the effect on CBD stone sizes and predicting factors on spontaneous passage in patients with cholangitis. MethodThe medical records of cholangitis at Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University from January 2014 to December 2019 were retrospectively reviewed. Patients with acute cholangitis from CBD stones underwent ERCP in the same admission were enrolled. ResultOf the 96 patients, The rate of spontaneous passage of CBD stones was 19.8%. By univariate analysis, factors significantly associated with a predictor of spontaneous CBD stone passage in patient with cholangitis were single CBD stone (p = 0.001), CBD stone diameter < 5 mm (p < 0.001), and clinical symptom improved before ERCP procedure (p = 0.004). Multivariate logistic regression analyses also revealed that these three factors were significantly associated with spontaneous passage. From ROC curve analysis, stone size of less than 4.85 mm was more likely to pass spontaneously with acceptable sensitivity (81.8%) and specificity (78.9%). ConclusionsCBD stone diameter < 5 mm, single CBD stone and improved clinical symptom before ERCP procedure are key predictors of spontaneous CBD stone passage in cholangitis.

Evaluation of the efficacy of masturbation on distal ureteral stones: a prospective, randomized, controlled study.

To evaluate the effect of masturbation on the spontaneous expulsion of distal ureteral stones 5-10mm in size. A total of 128 men with distal ureteral stones were randomly divided into 3 groups. All patients received standard medical therapy. Patients in group 1 (n = 43) were instructed to masturbate at least 3-4 times a week, patients in group 2 (n = 41) received tamsulosin 0.4mg/day, and patients in group 3 (controls, n = 44) received standard medical therapy alone. Rates of expulsion, need for analgesic, and ureterorenoscopic lithotripsy were compared between the groups. The mean ages of the patients in groups 1, 2, and 3 were 37 ± 5.0, 37.6 ± 4.6, and 38.4 ± 6.8years, respectively (p = 0.7). The mean stone size in each group was 6.93 ± 1.1mm, 7.1 ± 0.9mm, and 6.87 ± 1.1mm, respectively (p = 0.4). Spontaneous passage rates in groups 1, 2, and 3 were 81.4%, 80.5%, and 43.2%, respectively, and were significantly higher in group 1 (p = 0.001) and group 2 (p = 0.001) when compared with group 3. Analgesic requirement in groups 1, 2, and 3 was 1.7 ± 0.6, 1.5 ± 0.6, and 1.8 ± 0.6 times per day, respectively, and was significantly lower in the tamsulosin group than in the control group (p = 0.004) CONCLUSION: Masturbation and tamsulosin increased the spontaneous passage of distal ureteral stones 5-10mm in size. Masturbating at least 3-4 times a week was as effective as tamsulosin. Masturbation and tamsulosin also reduced the need for ureterorenoscopic lithotripsy.

S3062 Floss Your Pylorus: Accidental Ingestion of Dental Floss Pick With Pyloric Injury

INTRODUCTION: A dental floss pick is made of disposable two prongs extending from a thin plastic body of high-impact polystyrene material with a single thread of floss which runs between the two prongs. While the incidence of accidental toothpick ingestion among adults is not common and is considered a medical emergency. The incidence of floss toothpick ingestion is extremely rare and carries a similar risk. CASE DESCRIPTION/METHODS: A 27-year-old man with no PMH presented to the gastroenterology clinic complaining of epigastric abdominal pain awaking him from his sleep for the past three weeks. He reports the accidental swallowing of a dental floss pick 3 weeks prior to his visit. Labs were unremarkable. Cross-sectional imaging with an abdominal CT scan with contrast showed a filling defect in the shape of a pick in the region of the antrum of the stomach extending towards with pylorus with associated thickening of the stomach wall. Upper endoscopic evaluation was performed and demonstrated an impacted dental floss pick with the floss thread eroding into the pylorus (Image A). The dental floss pick was grasped and secured using a snare and gently detached from the pylorus resulting in a superficial pyloric ulceration. The dental floss stick was removed from the stomach using a snare and with the assistance of a flexible rubber hood in order to protect the esophageal and pharyngeal mucosa from sharp edge injury as well as to prevent dental pick floss entrapment in the pharyngeal airway upon withdrawal. The bell portion of the plastic hood was everted during withdrawal at the gastroesophageal junction with the toothpick side pointing away from the endoscope (Image B). Successful extraction of the dental floss stick was performed (Image C). DISCUSSION: To our knowledge this is the first reported case of a dental floss pick stick ingested and impacted in the gastrointestinal tract. While the incidence of unintentional toothpick pick ingestion is extremely rare with limited literature there is a body of literature discussing toothpick ingestions. With toothpick ingestions spontaneous passage of the toothpick is unlikely and there is an 18% mortality rate. The most common symptom is pain localized to the area of the impacted toothpick and if perforation of a major blood vessel occurs massive blood loss and shock can occur.Given that dental floss pick sticks have a wider base than toothpicks but still contain a sharp edge they too are unlikely to pass spontaneously and should prompt urgent endoscopic evaluation.Image A.: The dental floss stick eroding into Pylorus.Image B.: The dental floss stick removal using a snare and with the assistance of a flexible rubber hood.Image C.: Successful extraction of dental floss stick.

CT-related parameters and Framingham score as predictors of spontaneous passage of ureteral stones ≤ 10 mm: results from a prospective, observational, multicenter study

To investigate the reliability of newly defined CT-related parameters and cardiovascular risk factors in groups adjusted for stone size and location to predict spontaneous stone passage (SP) of uncomplicated ureteral stones ≤ 10mm. The data of 280 adult patients with solitary unilateral ureteral stones ≤ 10mm in diameter in non-contrast computed tomography were prospectively recorded. All patients undergoing a four-week observation protocol with medical expulsive therapy using tamsulosin were divided into two groups according to SP or no SP. Demographic, clinical and radiological findings of these groups were recorded. Spontaneous stone passage was observed in 176 (62.9%) of the patients, whereas the SP rate was 57.6% for 118 upper ureteral stones and 66.7% for 162 lower ureteral stones. The SP rate was 13.3 times greater with ureteral wall thickness < 1.88mm, 4.4 times greater with a ratio of ureter to stone diameter of < 1.24, 3.4 times greater with Framingham score of < 11.5%, 2 times greater with neutrophil lymphocyte ratio < 1.96, 1.9 times greater with ureteral diameter < 6.33mm and 1.5 times greater with stone volume < 38.54 mm3. Lower levels of ureteral wall thickness, ratio of ureter to stone diameter, Framingham score, neutrophil lymphocyte ratio, ureteral diameter, stone volume and absence of hydronephrosis were found to be more successful predictors. We consider that the success rate can be increased by selection of the proper option (observation or active treatment) according to these predictors.