Ureteral wall thickness as a significant factor in predicting spontaneous passage of ureteral stones of ≤ 10 mm: a preliminary report

Yoshida, Takashi; Inoue, Takaaki; Taguchi, Makoto; Omura, Naoto; Kinoshita, Hidefumi; Matsuda, Tadashi

doi:10.1007/s00345-018-2461-x

Cited by 34 publications

(38 citation statements)

References 20 publications

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“…Previous studies reported that the prevalence of the soft-tissue rim sign did not differ between patients with spontaneous stone passage and those who failed conservative management [14],and was not associated with the stone location or degree of obstruction [13,20].However, recent research on ureteral wall thickness (UWT) suggests that the soft tissue rim sign may be associated with delayed stone passage. Yoshida et al reported that higher UWT (> 2.7 mm) is associated with failed 4-week spontaneous stone passage [21]. In our study, we considered the soft tissue rim sign as positive when there is an obviously visible rim of soft tissue surrounding the ureteral stone, suggesting that only ureteral stones with a higher UWT were categorized as having a soft tissue rim sign.…”

Section: Discussionmentioning

confidence: 86%

Findings of Non-enhanced Abdominal Computed Tomography for Pain Management of Acute Renal Colic Patients in the Emergency Department

2020

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Study Objectives: To identify non-enhanced computed tomography (NECT) findings related to repeated requirement of painkiller, hospitalization and revisits within 5 days of discharge among acute renal colic patients. Patients and methods: A retrospective observational study was performed for all patients (age > 18 years) with acute renal colic who visited the emergency department (ED) between 2012 and 2015. NECT findings of acute ureterolithiasis (size, location, hydronephroureter, perinephric infiltrations and soft-tissue rim sign) were analysed for their relationships to repeated administration of painkiller, hospitalization and ED revisit. Results: Of total 862 patients enrolled, 305 (35.4%) required repeated administration of pain medication. In the NECT findings, hydronephroureter was more prevalent in the repeated administration of painkiller group (61.3% vs. 53.7%), but did not show independent relationship. Sixty-eight (7.9%) were hospitalized and 44 (5.1%) returned to the ED. The significant findings associated with hospitalization were hydronephroureter (OR [Odd Ratio] 1.92, 95%CI [Confidence Intervals] 1.04–3.54) and mid (5–7 mm) / large-size (> 7mm) ureteral stones (OR 2.66, 95% CI 1.49–4.76 and OR 4.78, 95% CI 1.80–12.70). The soft-tissue rim signs (OR 2.16, 95%CI 1.07–4.37) and proximal/mid location of stones (OR 3.21, 95% CI 1.26–8.20 and OR 2.53, 95% CI 1.19–5.37) were independently associated with ED revisit. Conclusions: Among the NECT findings of acute ureterolithiasis, hydronephroureter and stones > 5 mm in size were independently associated with the need of hospitalization. The soft-tissue rim sign and proximal/mid location of stones were independently associated with ED revisit within 5 days.

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Section: Discussionmentioning

confidence: 86%

Findings of Non-enhanced Abdominal Computed Tomography for Pain Management of Acute Renal Colic Patients in the Emergency Department

2020

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“…This is supported by the available evidence, which showed that UWT could serve as a potential predictive factor for SSP if UWT is less than 2.3 mm and may help physicians identify patients who require EI, especially if UWT is more than 2.71 mm. 17 , 18 , 22 Lastly, there is controversy in the literature regarding the role of ureteral diameter and the relation between ureteral and stone diameter in the prospect of SSP. 23 , 32 This study supports the idea that the increase in UWT and the dilatation of the urinary tract above the level of obstruction decrease the chance of SSP and promote EI.…”

Section: Discussionmentioning

confidence: 99%

“…Ureteral wall thickness (mm) (UWT): Measured as the point of greatest soft-tissue thickness around the circumference of the stone. 17 , 18 …”

Section: Radiological Variables Classificationmentioning

confidence: 99%

Clinical and Radiological Predictors of Early Intervention in Acute Ureteral Colic

Abushamma¹,

Ktaifan²,

Abdallah³

et al. 2021

IJGM

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Purpose Acute ureteric colic (AUC) is generally one of the most common reasons for emergency department attendance. Expectant management is recommended in non-complicated ureteral calculi. However, data regarding the optimal duration of observation or indications of early intervention (EI) are not well understood. This article describes the clinical and radiological factors that promote EI in AUC. Patients and Methods This was an observational and retrospective cohort study. Patients with AUC diagnosed based on non-contrast computerized tomography (NCCT) between 2019 and 2020 were enrolled in the study. These patients were classified into two main categories: spontaneous passage of stone (SSP) and EI. In addition, a comparative analysis was performed to identify clinical and radiological variables that promote EI. Results One-hundred and sixty-one patients were included. High WBCs are associated with a significant increase in EI. Forty-three percent (n=37) of patients with serum WBCs higher than 10 had an EI, while 23% had SSP (n=17; p <0.001). High CRP level is also significantly associated with EI (n=36; 86%; p <0.001). Upper and middle ureteral calculi are statistically associated with EI (n=54; 62%) in comparison to the SSP cohort (n=22; 30%; p <0.001). EI is also linked to the maximal length of ureteric calculi (MCL) of 9 mm (6–13mm), and HU density of stone of 700 (430–990) H.U ( p <0.001). Ureteric stone volume of 0.2 (0.06–0.3) cm 3 is significantly associated with EI ( p <0.001). Ureteral wall thickness of 3 (2–3 mm), the presence of extrarenal pelvis (n=20; 23%), and AP diameter of renal pelvis 18 (13–28 mm) are all significantly associated with a higher rate of EI ( p <0.001). Multiple binary logistic regression analysis showed that MCL is the strongest predictor of EI. Conclusion MCL is an independent and robust predictor of EI in AUC. Biochemical variables and radiological characteristics can also act as an adjunct to promote EI.

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“…Spontaneous stone passage and downward displacement of stones were encountered in 3.8 % and 3.4% of patients with successful URS, respectively. Yoshida et al concluded that in addition to the passive ureteral dilation caused by the ureteral stent, ureteral wall thickness is a substantial factor for spontaneous passage of ureteric stones ≤ 10 mm [27]. On the contrary, it was reported that spontaneous stone passage in patients with PCN was higher than in patients with RUS [8].…”

Section: Discussionmentioning

confidence: 99%

Predictors for Retrograde Ureteral Stenting Failure as an Initial Drainage Method for Emergent Complicated Acute Calculus Obstructive Uropathy

Elbaset¹,

Edwan²,

Abouelkheir³

et al. 2021

Société Internationale D’Urologie Journal

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Objective: To define predictors for initial retrograde ureteral stenting (RUS) failure with the need for the percutaneous nephrostomy (PCN) insertion as a drainage method in patients with complicated acute calculus obstructive uropathy. Methods: We undertook a retrospective evaluation of patients who presented with complicated obstructive calculus uropathy (acute renal failure or obstructive pyelonephritis) between January 2016 and January 2020. Patients in whom there was failure to visualize ipsilateral ureteric orifice and those with extrinsic ureteral obstruction were excluded. Patient demographics and radiological data including stone site, hydronephrosis grade, maximum transverse stone diameter, periureteral density (PUD) and pericalcular ureteric thickness (P-CUT) at the maximum transverse stone diameter were assessed using non-contrast computed tomography at the time of admission. Results: The study included 256 patients who were managed initially by RUS trial. Of them, 48 (18.8 %) had RUS failure. The presence of acute pyelonephritis, increased maximum transverse stone diameter ≥ 9.5 mm, P-CUT ≥ 7.5 mm, and PUD at stone level ≥ 17.5 HU were risk factors associated with RUS failure (P = 0.007, 0.002, < 0.001, and < 0.001, respectively). Conclusion: Initial radiological stone and ureteric characteristics, in addition to the clinical diagnosis of obstructive pyelonephritis, can be used to determine PCN insertion as the preferred option over RUS for urinary drainage.

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Ureteral wall thickness as a significant factor in predicting spontaneous passage of ureteral stones of ≤ 10 mm: a preliminary report

Abstract: UWT can serve as a potential predictive factor for 4-week SP and may help physicians to select patients who require immediate interventions among those with ≤ 10-mm ureteral stones.

Cited by 34 publications

References 20 publications

Findings of Non-enhanced Abdominal Computed Tomography for Pain Management of Acute Renal Colic Patients in the Emergency Department

Findings of Non-enhanced Abdominal Computed Tomography for Pain Management of Acute Renal Colic Patients in the Emergency Department

Clinical and Radiological Predictors of Early Intervention in Acute Ureteral Colic

Predictors for Retrograde Ureteral Stenting Failure as an Initial Drainage Method for Emergent Complicated Acute Calculus Obstructive Uropathy

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