Relationship Between Spontaneous Passage Rates of Ureteral Stones Less Than 8 mm and Serum C-Reactive Protein Levels and Neutrophil Percentages

Abstract

PurposeA ureter obstruction caused by a ureteral stone results in inflammatory changes in the proximal submucosal layer and prevents the spontaneous passage of the ureteral stone. Accordingly, we analyzed the relationship between the spontaneous passage rates of ureteral stones less than 8 mm in size and serum C-reactive protein (CRP) levels and neutrophil percentages.Materials and MethodsA total of 187 patients who were diagnosed with ureteral stones less than 8 mm in size and were managed consecutively at Keimyung University Dongsan Medical Center from January 2001 to January 2011 were retrospectively analyzed. Ureteral stone removal was defined as no ureteral stone shown in an imaging test without any treatment for 8 weeks after diagnosis. The patients were divided into three groups according to the levels of serum CRP and into two groups according to neutrophil percentage. The associations between these factors and ureteral stone passage rates were then examined.ResultsThe ureteral stone passage rates of the low serum CRP level group, the medium serum CRP level group, and the high serum CRP level group were 94.1% (159/169), 70% (7/10), and 50.0% (4/8), respectively. The passage rates of ureteral stones in the group with a normal neutrophil percentage and in the group with a higher neutrophil percentage were 94.5% (121/128) and 83.1% (49/59), respectively (p=0.011).ConclusionsMeasuring serum CRP levels and neutrophil percentages in patients with small ureteral stones of less than 8 mm is useful in predicting whether the stone will be spontaneously passed. When the serum CRP level and neutrophil percentage of a patient are high, aggressive treatment such as extracorporeal shock wave lithotripsy should be considered.

External validation of the STONE score and derivation of the modified STONE score

“…C-reactive protein could also be used as a predictor of spontaneous passage of ureter stones. Simple uncomplicated ureter stone patients might have low CRP levels [23,24]. The AUROC of the modified STONE and the sensitivity of the high score were significantly higher than those of the STONE score, which needs further multicenter external validation.…”

Predictive Factors for Spontaneous Stone Passage and the Potential Role of Serum C-Reactive Protein in Patients with 4 to 10 mm Distal Ureteral Stones: A Prospective Clinical Study

“…There's a controversy regarding the further optimal management of patients with ureteral stone following the initial treatment of ureteral colic pain (1)(2)(3). Options for the management of patients with ureteral stone include conservative management and active stone removal with minimal invasive techniques including ESWL and ureteroscopy (1,14).…”

“…Factors which can be used to predict SSP include stone diameter, duration of pain, presence of pyuria and hydronephrosis (2,3,8,9). Previously, the incidence of SSP fordistal ureteral stones was reported as 71-98% for stones ≤ 5mm and 25-51% for stones > 5mm (3,8).…”

“…Previously, the incidence of SSP fordistal ureteral stones was reported as 71-98% for stones ≤ 5mm and 25-51% for stones > 5mm (3,8). C-reactive protein (CRP) is an acute phase protein which M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 4 increases as a result of inflammation (2,3). Inflammatory response due to ureteral stone can cause a rise in serum CRP level.…”

“…Ureteral stone disease is responsible for 20% of urolithiasis cases and has a prevelance rate of 3% to 5% (1)(2)(3). Renal colic due to ureteral stones may negatively affect the patients' quality of life and routine daily activities causing significant pain and discomfort (1,4).…”