Category: Clinical Stones: Outcomes

MP8-15 - Patients with proximal ureteral stones - who will benefit most from expectant management?

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective :

Proximal ureteral stones tend to be larger and have lower rates of spontaneous expulsion than distal ureteral stones. While many of these patients are offered immediate intervention after diagnosis with either drainage or definitive treatment some patients do well with expectant management. Identification of risk factors for intervention among patients with proximal ureteral stones may better stratify this group to patients with higher and lower risk for intervention, which can assist in pinpointing the patients suitable for conservative management.

Our aim was to identify risk factors for intervention in patients with proximal ureteral stones.

Methods :

We retrospectively reviewed the medical charts of patients presented to the emergency department with symptoms of renal colic and underwent abdominopelvic computerized tomography (CT) between August 2016 and April 2017. A total of 97 consecutive patients were identified with ureteral stones proximal to the common iliac vessels and up to 10mm in diameter. We collected patients' demographics, clinical, and imaging data and performed binary regression analysis for risk of intervention.

Results :

97 consecutive patients were identified with average age of 49.2y (range 17-97) and stone size of 7.1mm (range 3-10).

41 patients underwent immediate intervention while the remaining 56 patients were treated conservatively. Of the 56 patients treated conservatively, 26 underwent delayed Intervention while 30 reported spontaneous stone expulsion.

On univariate analysis of all 97 patients the following statistically significant risk factors for intervention were found - stone length, age, serum lymphocyte, platelet counts and stone density.  Of these risk factors stone length≥7mm (p=0.012, OR 5.4) and platelet count≤230K/µL (p=0.027, OR 4.9) remained statistically significant on multivariate analysis.

The rate of intervention in patients with both risk factors was 94.1% vs 26.1% in patients with no risk factors.

When applied to the 56 patients treated conservatively, patients with no risk factors had 15% intervention rate compared with 88% in patients with both risk factors.
In a subgroup analysis according to stone length, in stones≥7mm Neutrophil to Lymphocyte Ratio (NLR) was statistically significant higher in the intervention group compared with expulsion (6.7 vs 2.8,p=0.017).

Conclusions :

We found that stone length and platelet count were found to be risk factors for intervention in patients with up to 10mm proximal ureteral stones. These findings require validation and may assist in identifying patients that are more suitable for conservative approach.

Igal Shpunt

Urological Resident
Kaplan Medical Center
Shoham, HaMerkaz, Israel

Etay Elbaz

Tel Aviv, Tel Aviv, Israel

Jonathan Modai

Kaplan Medical Center
Tel Aviv, Tel Aviv, Israel

Jonathan Modai, MD, Resident of Urology in Kaplan Medical Center

Yuval Avda

Urology Resident
Kaplan Medical Center
Rehovot, HaMerkaz, Israel

Yuval Avda, MD, Urology resident, Kaplan Medical Center, Rehovot, Israel

Dan Leibovici

Rishon le zion, HaMerkaz, Israel

Uri Lindner

Tel Aviv, Tel Aviv, Israel

Yaniv Shilo

Ramat Gan, HaMerkaz, Israel