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Natural history of conservatively managed ureteric stones from a cumulative analysis of 6600 patients

Natural history of conservatively managed ureteric stones from a cumulative analysis of 6600 patients
Natural history of conservatively managed ureteric stones from a cumulative analysis of 6600 patients

Introduction 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. Methodology Literature search was performed using Cochrane and PRISMA guidelines. Outcome measures were patient and stone demographics, expulsion rates, expulsion times, side effect 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. Results 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 <5mm and 62% of stones ≥5mm passed spontaneously. The average time to stone expulsion was about 17 days (range 6-29 days). 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. Conclusion We believe this current review is the largest study for the evaluation of natural history of ureteric stones. The evidence suggests that ureteric stones will pass without intervention in 64% of patients, however this varies from nearly 50-75% depending on the size and location, in the span of 1-4 weeks.

Journal Article
0892-7790
371-379
Yallappa, Sachin
9c6638ce-95af-440f-a7d5-d6e53006260e
Amer, Tarik
34b3aacc-a0bb-4f35-ae65-6808574e6c1f
Jones, Patrick
d27beb5b-0e09-4ed5-89f0-6c62421c2397
Greco, Francesco
105d81e2-d2fc-4fd5-bef4-118f1d180675
Tailly, Thomas
c64befe9-ebc2-4b6b-acd6-ab72c7756384
Somani, Bhaskar
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Eronini, Nkem Umez
c2c85d52-76ee-46d2-b582-bd55f483ff15
Aboumarzouk, Omar M
3c7e2433-638d-4378-9931-902fdc68acce
Yallappa, Sachin
9c6638ce-95af-440f-a7d5-d6e53006260e
Amer, Tarik
34b3aacc-a0bb-4f35-ae65-6808574e6c1f
Jones, Patrick
d27beb5b-0e09-4ed5-89f0-6c62421c2397
Greco, Francesco
105d81e2-d2fc-4fd5-bef4-118f1d180675
Tailly, Thomas
c64befe9-ebc2-4b6b-acd6-ab72c7756384
Somani, Bhaskar
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Eronini, Nkem Umez
c2c85d52-76ee-46d2-b582-bd55f483ff15
Aboumarzouk, Omar M
3c7e2433-638d-4378-9931-902fdc68acce

Yallappa, Sachin, Amer, Tarik, Jones, Patrick, Greco, Francesco, Tailly, Thomas, Somani, Bhaskar, Eronini, Nkem Umez and Aboumarzouk, Omar M (2018) Natural history of conservatively managed ureteric stones from a cumulative analysis of 6600 patients. Journal of Endourology, 32 (5), 371-379. (doi:10.1089/end.2017.0848).

Record type: Review

Abstract

Introduction 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. Methodology Literature search was performed using Cochrane and PRISMA guidelines. Outcome measures were patient and stone demographics, expulsion rates, expulsion times, side effect 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. Results 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 <5mm and 62% of stones ≥5mm passed spontaneously. The average time to stone expulsion was about 17 days (range 6-29 days). 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. Conclusion We believe this current review is the largest study for the evaluation of natural history of ureteric stones. The evidence suggests that ureteric stones will pass without intervention in 64% of patients, however this varies from nearly 50-75% depending on the size and location, in the span of 1-4 weeks.

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e-pub ahead of print date: 26 February 2018
Published date: May 2018
Keywords: Journal Article

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Local EPrints ID: 421208
URI: http://eprints.soton.ac.uk/id/eprint/421208
ISSN: 0892-7790
PURE UUID: 4b4f5bc4-cc7f-40cf-83ba-b80a67fea368

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Date deposited: 24 May 2018 16:31
Last modified: 16 Dec 2019 18:21

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Contributors

Author: Sachin Yallappa
Author: Tarik Amer
Author: Patrick Jones
Author: Francesco Greco
Author: Thomas Tailly
Author: Bhaskar Somani
Author: Nkem Umez Eronini
Author: Omar M Aboumarzouk

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