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

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.

More information

Identifiers

Catalogue record

Export record

ASCII CitationAtomBibTeXData Cite XMLDublin CoreDublin CoreEP3 XMLEndNoteHTML CitationHTML CitationHTML ListJSONMETSMODSMPEG-21 DIDLOpenURL ContextObjectOpenURL ContextObject in SpanRDF+N-TriplesRDF+N3RDF+XMLRIOXX2 XMLReferReference ManagerSimple Metadata

Altmetrics