Category: Basic Science: Stones

MP2-16 - Predictive Value of C-reactive Protein in the Expulsion of Ureteral Stones (6-10 Millimeters) from the Lower Third

Thu, Sep 20
4:00 PM - 6:00 PM

Introduction & Objective : Ureteral lithiasis is responsible for 20% of cases of urolithiasis and has a prevalence of 3 to 5%, kidney colic due to ureteral stones can negatively affect quality of life and represents a urological emergency, the majority of the stones of the distal ureter smaller than 6 Millimeters (Mm) can pass spontaneously through the ureter for which the conservative therapy is optimal. Serum C reactive protein (CRP) is a marker of acute phase inflammation, being useful the prediction of expulsion of distal ureteral stones of 6−10  Mm.  To analyze the predictive values of C−reactive protein for expulsion of stones of 6−10 Mm in the lower third of the ureter


Methods : Between October 2015 and November 2017,a  quantitative, prospective, cohort study will be carried out, including 187 patients with acute renal colic secondary to a stone in the lower ureter of 6−10 mm and receiving medical expulsive therapy treated at our center until spontaneous  stone passage or surgery with ureteroscopy after 4 weeks, will take sociodemographic variables, follow up time and intervention record will be operationalized and statistical analysis will be performed and determine CRP cut off point with receiver operator characteristic (ROC) curve for prediction ureteral stone passage.


Results : Of the 187 enrolled patients with distal ureteric calculi, 175 completed the study. The mean age of patients was 33.2 years and the male to female ratio was 2.3:1. Spontaneous stone expulsion within 4 weeks was recorded in 112 patients (64 %) and 63 patients (36 %) underwent ureteroscopy for stone extraction because of failure of spontaneous stone expulsion in this patients, urosepsis in one patient, and uncontrollable pain in 11 patients. A cut off point of 17.2 mg/L is appropriate in the stone expulsion.


Conclusions :

Medical expulsive therapy success for management of small distal ureteric calculi could be predicted with serum CRP. Patients with high level of serum CRP have low stone expulsion rate and should directly be subjected for an immediate, minimally invasive ureteroscopy.

Enrique Omar Piñon Solis

Resident
Instituto de Salud del Estado de Mexico
Toluca, Distrito Federal, Mexico

Enrique Omar Piñon Solis

Resident
Instituto de Salud del Estado de Mexico
Toluca, Distrito Federal, Mexico

Jorge Garcia Ramirez

Resident
Instituto de Salud del Estado de Mexico
Toluca, Distrito Federal, Mexico

Jose Fernando Gil Garcia

Urologist
Instituto de Salud del Estado de Mexico
Toluca, Distrito Federal, Mexico

Jorge Valdez Colin

Urologist
Instituto de Salud del Estado de Mexico
Toluca, Distrito Federal, Mexico

Alejandro Noyola Guadarrama

Distrito Federal, Mexico