Natural History and Current Concepts for the Treatment of Small Ureteral Calculi

Predicting intervention in renal colic patients after emergency department evaluation

“…The important question of predicting intervention in renal colic has, for decades, only been addressed through retrospective studies showing that persistence of pain, size of calculus, location along the ureter, impaired renal function, obstruction and signs of infection are important factors influencing intervention. 8,15,[19][20][21][22][23] Our predictive variables for intervention are remarkably similar to other studies 8,12,15,[23][24][25] and demonstrate that our sample of renal colic patients is comparable to other populations described in the literature. 14,[26][27][28] Although not all patients had an intervention or were enrolled in the study, we Not enrolled in study n = 81…”

“…Urological follow-up for definitive treatment after ED discharge is not standardized because of the lack of validated criteria to prioritize patients. [13][14][15] Our prospectively derived model of 3 simple variables -a ureteral calculus measuring 6 mm or more, a calculus situated above the mid-ureter, or residual pain at discharge -predicted a high likelihood of urological intervention. If at least 1 of the variables was present, the model's sensitivity and specificity were 92% and 63% respectively.…”

“…Complications from an intervention for ureteral obstruction are much higher when symptoms exceed 4 weeks' duration. 15,16 Irreversible renal damage can occur with urinary obstruction that impairs renal function for over 2 weeks. 5,[29][30][31] In the US, the societal burden and indirect costs for lost wages from urolithiasis are estimated to be US$139 million annually.…”

“…Despite this, studies conducted in different geographic locations have obtained similar results to our study. 8,15,23,25 At the time of this study, IVP was the imaging study of choice at our institution because of its availability and ability to assess renal function and obstruction. Given that CT scanning is becoming the imaging modality of choice for diagnosing urolithiasis, future validation of this decision rule should use CT scan.…”

“…Patients with persistent or recurrent pain who are waiting for procedures are repeatedly seen in the ED; this contributes to an increased risk of complications for the patients, and increased health care costs and ED patient volumes. [13][14][15][16] If intervention is unlikely after the initial ED evaluation, patients could be referred for further assessment and follow-up to their family physician rather than to a urologist. A valid decision tool to identify on initial ED visit those renal colic patients who will likely eventually undergo a procedure would allow emergency physicians to prioritize and standardize referrals for urological treatment.…”