Evolving Guidance on Ureteric Calculi Management in the Acute Setting

Abstract

Ureteric colic is a common presentation to acute emergency services. The gold standard test for the diagnosis of acute ureteric colic is a non-contrast computer tomography of the kidneys ureters and bladder (CT KUB). Non-steroidal anti-inflammatory drugs (NSAIDs) should be used as first-line analgesia, with studies showing that there is no role for steroid or phosphodiesterase-5 inhibitors. There is emerging evidence that a high body mass index (BMI) is a risk factor. The drugs used to facilitate stone passage are known as medical expulsive therapy (MET). The most evaluated being alpha-blockers. The Spontaneous Urinary Stone Passage Enabled by Drugs (SUSPEND) trial was designed to evaluate the use of MET (tamsulosin and nifedipine). This trial showed that there was no difference with MET and placebo for the spontaneous passage of ureteric stones. There is an emerging role for the use of primary ureteroscopy in the management of non-infective ureteric stones.

Urgent ureterorenoscopy as a primary treatment for ureteral stone: why not?

“…The overall prevalence varies between 1 and 20% [ 8 – 11 ]. Obesity, which is one of the most important diseases that has been increasing in recent years and threatening health, and in parallel with the sedentary lifestyle and fast-food culture that has increased in this way, stone disease is increasing day by day [ 5 , 12 , 13 ]. Depending on this situation, there is an increase in the rate of admission to the emergency department or urology department due to renal colic [ 14 , 15 ].…”

“…For this purpose, while non-steroidal anti-inflammatory drugs (diclofenac, ibuprofen, ketorolac, etc.) are used most often, paracetamol, antispasmodic and opioid type drugs are also used [ 4 , 5 ]. After analgesia is planned, definitive treatment planning is made according to the patient’s clinical, imaging and laboratory evaluations.…”

Comparison of prone vs. supine unenhanced CT imaging in patients with clinically suspected ureterolithiasis

“…With the management trend shifting to primary endoscopic removal of ureteric calculi, we think that it is particularly important to accurately locate distal ureteral calculi [ 15 – 18 ].…”

Ureteroscopy for stone disease: expanding roles in the modern era

“…The trend appears to be moving towards day case URS, with England seeing a three-fold increase in the number of treatments from 2006/07 to 2013/14 [1]. URS is also being used increasingly in the acute setting for primary management of ureteric calculi [5]. In addition to the use of URS as a treatment option for standard ureteric and renal calculi, it has an expanding role in treating patients with more complex stone disease or with co-morbidities (Table 1).…”

“…Although temporising measures like insertion of a JJ stent or nephrostomy might be options, there is a move towards URS in an acute setting provided surgical experience and expertise is available for it [5]. …”