Is computed tomography-defined obstruction a predictor of urological intervention in emergency department patients presenting with renal colic?

Abstract

Introduction: Our objective was to determine whether unilateral calculus-induced ureteric obstruction on computed tomography (CT) was independently associated with the need for urological intervention and 30-day return to the emergency department (ED). Methods:We performed a retrospective cohort study of patients with symptomatic urinary calculi diagnosed by unenhanced helical CT. Stepwise regression analysis was used to determine the predictors of urological intervention and 30-day return to the ED. Potential predictors assessed included: patient demographics, calculus size, calculus location, degree of obstruction, analgesic doses, signs and symptoms of infection, serum creatinine, cumulative intravenous fluid administered, and the prescription of medical expulsive therapy. Results: Of 195 patients, 81 (41.5%) underwent urological intervention. The size of the calculus, its location, and the cumulative opioid dose were all independent predictors for urological intervention. Every 1 mm increase in calculus size increased the likelihood of intervention 2.2 times (odds ratio [OR] 2.17; 95% confidence interval [CI] 1.67-2.85). Proximal stones were 4.7 times more likely to require intervention than distal calculi (OR 0.21; 95% CI 0.09-0.49). Every 10 mg increase in morphine was associated with a 30% increase in the odds of intervention (OR 1.30; 95% CI 1.07-1.58). Degree of obstruction was not associated with the need for urological intervention. Finally, none of the variables were predictors for 30-day return to the ED. Conclusions: Although stone size, proximal location, and severe pain, as indicated by higher opioid doses, were associated with the need for intervention, the degree of obstruction did not influence the management of patients with CT-defined urinary calculi.

Development and validation of a score for emergency intervention in patients with acute renal colic secondary to ureteric stones

“…A stone length >5 mm and upper ureteric stone location were significant risks for the need of intervention in most previous reports [ 5 , 7 , 11 ], as well as the present study. This can be explained by the natural history of ureteric calculi.…”

“…Massaro et al [ 11 ] in 2017, evaluated predictors of urological intervention for CT-detected calculi causing ureteric obstruction. They had found that stone size, proximal ureteric location and severe pain (as indicated by higher opioid doses) were associated with the need for intervention within 30 days of presentation.…”

The diagnostic yield of computed tomography in the management of acute flank pain and the emergency intervention rate for a proven acute ureteric stone

“…In a small Canadian retrospective series of 195 patients who presented with a ureteric calculus, 41% underwent intervention based on CT evidence of ureteric obstruction. 21 Stone size, a more proximal location and severe pain were associated with intervention but the degree of obstruction (a highly subjective measurement) did not influence management. Interestingly, none of the variables studied were predictive of readmission within 30 days.…”

What are the clinical effects of the different emergency department imaging options for suspected renal colic? A scoping review

“…In 9 studies, the urologic procedure rate varied from 6% (at 7 days) to 33% (at 30-60 days) (Table 9a and 9b in Supplement B). 22,23,24,59,[62][63][64][65][66][67][68][69][70] The only large population-level study showed a procedure rate of 13% in patients aged 18-64 years who were initially discharged from the ED. Stone size and location (as judged via CT), pain scores on discharge, and having private health insurance were found to be associated with a subsequent intervention in some studies.…”