Category: Clinical Stones: Medical Management
Introduction & Objective :
Ureteric colic has a lifetime prevalence of 10% to 15% and is one of the most common emergency urological presentations. Current EAU recommends conservative management for ‘small’ (<6mm) ureteral stones if active removal is not indicated.
It is important to understand the natural history of ureteric stone disease to help counsel patients with regards to their likelihood of stone passage and anticipated time frame with which they could be safely observed. We aimed to conduct a systematic review to better establish the natural history of stone expulsion.
Literature search was performed using Cochrane and PRISMA guidelines. Outcome measures were patient and stone demographics, expulsion rates, expulsion times, side effects of the medication.
A cumulative analysis, with subgroup analysis performed on stone location and size. The results were depicted as percentages and an intention to treat basis was used.
The literature search identified 70 studies and total of 6642 patients, with a median age of 46 and range of 18-74 years.
Overall 64% patients successfully passed their stones spontaneously. About 49% of upper ureteric stones, 58% of mid ureteric stones, and 68% of distal ureteric stones passed spontaneously.
Almost 75% of stones Nearly 5% of participants required rehospitalisation due to a deterioration of their condition and only about 1% of patients experienced side effects from analgesia provided.
We believe that current study is the largest evaluation of natural history of ureteric stones and redefines the rate of passage of stones in relation to the size and location compared to previous published literature and current international urolithiasis guidelines. We believe this will aid counselling of patients when it comes to deciding management options
Sachin Yallappa– Urology Trainee, West Midlands UK, Birmingham, England, United Kingdom
Tarik Amer– Glasgow, England, United Kingdom
Francesco Greco– Rocca di Neto, Abruzzi, Italy
Thomas Tailly– Consultant Urologist, University Hospital Ghent, Gent, Oost-Vlaanderen, Belgium
Bhaskar Somani– Consultant Urologist, Associate Professor, University Hospital Southampton , U.K, Southampton, England, United Kingdom
Nkem Umez Eronini– Glasgow, Scotland, United Kingdom
Omar Aboumarzouk– Urology Consultant, Glasgow Urological Research Unit, Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK, Glasgow, Scotland, United Kingdom
University Hospital Ghent
Gent, Oost-Vlaanderen, Belgium
Thomas Tailly graduated as a medical doctor from the Catholic University Leuven, Belgium in 2007. He went on to complete his urology residency training in 2013 in Belgium at the same institution, where he developed a special interest in urolithiasis in all its aspects and minimally invasive treatment modalities of both benign and malignant pathologies. As a resident he seated on multiple boards of national urological organisations and was active in the European Society of Residents in Urology. After completing an Endourology Fellowship in London, Ontario, at Western University under the supervision of Dr. John Denstedt, Dr. Stephen Pautler and Dr. Hassan Razvi, he took a position as consultant urologist in the University Hospital of Ghent in Belgium. During his fellowship he finished a Master of Science degree in Surgery, with a special interest in urological stent and catheter design, biomaterial and coatings. Apart from his clinical work as the primary stone surgeon of the hospital, he is currently involved in both clinical and translational research on urolithiasis and its diagnostic and treatment modalities.
Consultant Urologist, Associate Professor
University Hospital Southampton , U.K
Southampton, England, United Kingdom
Bhaskar is an Endourologist and Associate Professor in Southampton, and is an active member of European School of Urology 'Training and Research group' and ESUT Endourology group. He has been teaching on EUREP hands-on-training for the last 5 years and is the senior author in the new ‘Endoscopic stone treatment (EST)’ curriculum established for training and examinations. He has performed live surgery in EAU with presentations and moderations in EULIS, WCE and SIU. He is also a member of EAU ‘Train the Trainer’ committee.
He is research active and has published more than 200 papers with over 300 published abstracts/presentations. He is on the editorial board of 3 journals, a reviewer for 14 journals and Investigator for 5 trials. He sits on the MCQ panel for FRCS examinations and is a ‘Specialist advisor’ to National Institute of Clinical Excellence (NICE) Interventional procedures and ‘Invited expert’ to NICE urological infections. He is an elected member of BAUS Academic section and was recently selected as a Fellow of Faculty of Surgical Trainers.