Spontaneous Passage of Upper Urinary Tract Calculi in Relation to Composition

Ohkawa, Mitsuo; Tokunaga, Shuji; Nakashima, Tsutomu; Yamaguchi, Kazuyou; Orito, Matsuo; Hisazumi, Haruo

doi:10.1159/000282474

Cited by 14 publications

(4 citation statements)

References 14 publications

(20 reference statements)

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“…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…”

Section: Discussionsupporting

confidence: 86%

Predicting intervention in renal colic patients after emergency department evaluation

Papa

Stiell

Wells

et al. 2005

CJEM

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Objectives:There is no set of prospectively validated criteria to identify the emergency department (ED) patients with renal colic who are most likely to eventually have to undergo an intervention. This study prospectively assessed predictors of intervention in this patient population. Methods: This prospective cohort study included adult patients with renal colic who presented to 2 tertiary care hospital EDs. Patients had an 18-variable data form completed by an emergency physician and a radiological study to confirm urolithiasis. After discharge, patients were followed at 1 and 4 weeks to assess for intervention. The outcome criteria included the patient having had at least 1 of the following procedures performed: extracorporeal shockwave lithotripsy (ESWL), ureteroscopy, percutaneous nephrostomy or open surgery. Data were analyzed using appropriate univariate techniques, and those variables associated with intervention were combined using logistic regression analysis. Results: Over an 8-month period, 245 patients with confirmed urolithiasis were followed; 20% (95% confidence interval [CI] 15%-25%) eventually had a procedure to remove their calculi. Three variables were significantly correlated with having a procedure: i) size of calculus ≥ 6 mm (odds ratio [OR] 10.7, 95% CI 4.6-24.8), ii) location of calculus above mid-ureter (OR 6.9, 95% CI 3.0-15.9), and iii) Visual Analogue Scale score for pain at discharge from the ED ≥ 2 cm (OR 2.6, 95% CI 1.0-6.8). The area under receiver operating characteristic curve was 0.77 (95% C I 0.70-0.84) (p < 0.001). If all variables were present there was a 90% probability of the patient having an intervention performed within 4 weeks of discharge from the ED. Conversely, if none of the variables were present there was only a 4% probability of an intervention. Overall, the model had a sensitivity of 92% (95% CI 89%-96%) and a specificity of 63% (95% CI 57%-69%). Conclusions: This study has identified variables that could potentially be used to identify those renal colic patients who require an intervention after ED evaluation. Future studies will prospectively validate this model. RÉSUMÉObjectifs : Il n'existe pas d'ensemble de critères validés prospectivement pour identifier les patients reçus au département d'urgence pour une colique néphrétique qui sont les plus susceptibles EM ADVANCES • INNOVATIONS EN MU

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Section: Discussionsupporting

confidence: 86%

Predicting intervention in renal colic patients after emergency department evaluation

Papa

Stiell

Wells

et al. 2005

CJEM

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“…Our ESWL rates were corrected for numbers of stones per patient and duration of stone disease. CaP stones may be larger than CaOx stones, and less able to pass [15,24], so more ESWL is needed. CaP patients required surgery for stone removal more often than CaOx stone formers before ESWL was available [25].…”

Section: Eswl and Cap Stonesmentioning

confidence: 99%

Clinical implications of abundant calcium phosphatein routinely analyzed kidney stones

Parks¹,

Worcester²,

Coe³

et al. 2004

Kidney International

194

155

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“…Few studies on natural history of stone expulsion detailed the overall mean MSD of SPS, which ranged between 5.4 to 6.3 mm [5,19,12]. In another study, only 47 out of 566 SPS (8%) were found to have a MSD ≥6 mm.…”

Section: Discussionmentioning

confidence: 99%

“…Altogether, only sparse data regarding spontaneous stone passage according to stone size are available to date [11]. Particularly, only few studies to date have considered the relationship between the size of spontaneously passed stones (SPS) and patient or stone clinical factors such as age, sex and stone composition [7,12,13]. Further evaluation of these parameters could provide novel insights that may ultimately impact on recommendations for conservative stone treatment.…”

Section: Introductionmentioning

confidence: 99%

Stone composition independently predicts stone size in 18,029 spontaneously passed stones

et al. 2019

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PURPOSE To evaluate whether the size of spontaneously passed stones (SPS) may be associated with clinical parameters. METHODS A search for SPS was conducted in our electronic stone database, comprising data on stones analyzed over the last 33 years at our institution. Adults with upper urinary tract stones were included. Cases with stenotic urinary tract disease or past history of anastomotic urinary tract surgery were excluded. Stone size expressed as maximal stone diameter (MSD) and stone volume (SV) was compared between groups by one-way ANOVA. Logistic regression analyses were performed to identify predictors of MSD 6 mm. RESULTS Overall mean MSD and SV for 18,029 SPS was 4.1 mm and 11.5 mm 3 , respectively, and significantly differed between stone composition groups (p < 0.001). The lowest mean MSD and SV were found for calcium oxalate monohydrate (3.6 mm and 9.0 mm 3 , respectively) and the highest mean MSD and SV were found for struvite (7.9 mm and 61.0 mm 3 , respectively). Stone composition and increasing age were found to be independent predictors of MSD 6 mm (both p < 0.001). Sex differentiation did not contribute as a predictor of MSD 6 mm. CONCLUSIONS Stone composition and-to a lesser extent-age serve as independent predictors of size of spontaneously passed stones. Of particular importance, large spontaneously passed stones of 6 mm may be frequently found in cystine, brushite or struvite stone formers, whereas a minority of all calcium oxalate stones exceed that cutoff. Future studies shall evaluate these parameters as possible predictors of spontaneous stone passage. AbstractPurpose: To evaluate whether size of spontaneously passed stones (SPS) may be associated with clinical parameters. Methods:A search for SPS was conducted in our electronical stone database, comprising data on stones analyzed over the last 33 years at our institution. Adults with upper urinary tract stones were included. Cases with stenotic urinary tract disease or past history of anastomotic urinary tract surgery were excluded. Stone size expressed as maximal stone diameter (MSD) and stone volume (SV) was compared between groups by one-way ANOVA. Logistic regression analyses were performed to identify predictors of MSD ≥6 mm. Results:Overall mean MSD and SV for 18'029 SPS was 4.1 mm and 11.5 mm 3 , respectively, and significantly differed between stone composition groups (p<0.001).Lowest mean MSD and SV was found for calcium oxalate monohydrate (3.6 mm and 9.0 mm 3 , respectively) and highest mean MSD and SV was found for struvite (7.9 mm and 61.0 mm 3 , respectively). Stone composition and increasing age were found as independent predictors of MSD ≥6 mm (both p<0.001). Sex differentiation did not contribute as a predictor of MSD ≥6 mm. Conclusions:Stone composition and -to a lesser extent -age serve as independent predictors of size of spontaneously passed stones. Of particular importance, large spontaneously passed stones of ≥6 mm may be frequently found in Cystine, Brushite or Struvite stone formers, whereas a minority of al...

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Spontaneous Passage of Upper Urinary Tract Calculi in Relation to Composition

Cited by 14 publications

References 14 publications

Predicting intervention in renal colic patients after emergency department evaluation

Predicting intervention in renal colic patients after emergency department evaluation

Clinical implications of abundant calcium phosphatein routinely analyzed kidney stones

Stone composition independently predicts stone size in 18,029 spontaneously passed stones

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