CUA Guideline: Management of ureteral calculi

Ordon, Michael; Andonian, Sero; Blew, Brian; Schuler, Trevor; Chew, Ben H.; Pace, Kenneth T.

doi:10.5489/cuaj.3483

Cited by 84 publications

(62 citation statements)

References 150 publications

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“…Although there are relatively clear guidelines for the treatment of urinary calculi on the basis of stone size, it is unclear if other criteria, such as the presence of ureteric obstruction, qualify for more active intervention. 2,3 Knowledge of the predictors for intervention in urinary calculi may further guide the timing and nature of urological management, ED patient disposition, allow for a more efficient allocation of healthcare resources, and reduce patient discomfort.…”

Section: Introductionmentioning

confidence: 99%

Is computed tomography-defined obstruction a predictor of urological intervention in emergency department patients presenting with renal colic?

Massaro

Atkinson

Pawsey

et al. 2017

CUAJ

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Introduction: Our objective was to determine whether unilateral calculus-induced ureteric obstruction on computed tomography (CT) was independently associated with the need for urological intervention and 30-day return to the emergency department (ED). Methods:We performed a retrospective cohort study of patients with symptomatic urinary calculi diagnosed by unenhanced helical CT. Stepwise regression analysis was used to determine the predictors of urological intervention and 30-day return to the ED. Potential predictors assessed included: patient demographics, calculus size, calculus location, degree of obstruction, analgesic doses, signs and symptoms of infection, serum creatinine, cumulative intravenous fluid administered, and the prescription of medical expulsive therapy. Results: Of 195 patients, 81 (41.5%) underwent urological intervention. The size of the calculus, its location, and the cumulative opioid dose were all independent predictors for urological intervention. Every 1 mm increase in calculus size increased the likelihood of intervention 2.2 times (odds ratio [OR] 2.17; 95% confidence interval [CI] 1.67-2.85). Proximal stones were 4.7 times more likely to require intervention than distal calculi (OR 0.21; 95% CI 0.09-0.49). Every 10 mg increase in morphine was associated with a 30% increase in the odds of intervention (OR 1.30; 95% CI 1.07-1.58). Degree of obstruction was not associated with the need for urological intervention. Finally, none of the variables were predictors for 30-day return to the ED. Conclusions: Although stone size, proximal location, and severe pain, as indicated by higher opioid doses, were associated with the need for intervention, the degree of obstruction did not influence the management of patients with CT-defined urinary calculi.

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Section: Introductionmentioning

confidence: 99%

Is computed tomography-defined obstruction a predictor of urological intervention in emergency department patients presenting with renal colic?

Massaro

Atkinson

Pawsey

et al. 2017

CUAJ

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“…1,2 However, retropulsion of stone fragments are frequently seen during laser lithotripsy especially when using high energies for ureteral stones. 3,4,5,6 This necessitates the use of expensive and fragile flexible ureterosopes to look for the migrated renal stones. Sometimes, it is not possible to extract all renal stone fragments resulting in residual stone fragments.…”

Section: Introductionmentioning

confidence: 99%

Moses technology in a stone simulator

Ibrahim

Badaan

Elhilali

et al. 2017

CUAJ

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“…In yet another study, spontaneous passing of ureteral calculi occurred in 76% of the patients with ureteral stones of <5mm, in 60% of the patients with stones of 5-7mm and in 48% of the patients with stones of 7-9mm. 17 Although treatment modalities are different and include CT scan, they have though minimal, deleterious effects on the patients. 18,19 Most of the patients with UVJ and pre UVJ stones manifest LUTS.…”

Section: Discussionmentioning

confidence: 99%

Role of dilatation of intramural ureter in patients with lower urinary tract symptoms (LUTS) in UVJ and pre UVJ calculus: an observational study

2017

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Background: Various literature sources describe three narrowest anatomic spots in the ureter as the most potential points for ureteric calculi to form and these are: the pelvi-ureteric junction (PUJ), the point where the ureters cross over the iliac vessels and the ureterovesical junction (UVJ).Methods: This study included patients who presented with symptomatic obstructing ureteric calculi and who required uretero renoscopic lithotripsy (URSL). The procedure was selected according to stone size, location and degree of impaction.Results: Of the total of 100 patients, 43 were females and 57 were males. 69 patients had Lower Urinary Tract Symptoms and 31 patients had no Lower Urinary Tract Symptoms with the calculi. The age of the patients ranged from 17 years to 65 years and the stone size ranged from 7mm to 15mm. Lower ureteric calculi with LUTS are good indicators.Conclusions: We can approach lower ureteric calculi without use of dilators or 6/7.5ureteroscope in patients with LUTS.

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CUA Guideline: Management of ureteral calculi

Cited by 84 publications

References 150 publications

Is computed tomography-defined obstruction a predictor of urological intervention in emergency department patients presenting with renal colic?

Is computed tomography-defined obstruction a predictor of urological intervention in emergency department patients presenting with renal colic?

Moses technology in a stone simulator

Role of dilatation of intramural ureter in patients with lower urinary tract symptoms (LUTS) in UVJ and pre UVJ calculus: an observational study

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