Patient Reported Outcomes Predicting Spontaneous Stone Passage May Not Have Acceptable Accuracy

McLarty, Ryan; Assmus, Mark; Schuler, Trevor; Wollin, Timothy A.; De, Shubha

doi:10.1097/ju.0000000000001030

Cited by 10 publications

(7 citation statements)

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“…Yoshida et al [9] found that the number of patients with a history of urinary stone disease was significantly lower in the SSP group. Finally, McLarty et al [21] reported that stone history did not differ between the SSP and non-SSP groups. According to our univariate analysis, presence of hydronephrosis and a previous urolithiasis history were significant parameters.…”

Section: Discussionmentioning

confidence: 92%

“…A multicenter retrospective cohort study of 2,158 conservatively managed patients reported the SSP rates as 83%, 70%, and 52% for the distal, middle, and proximal ureteral stones, respectively and 89%, 49%, and 29% for <5 mm, ≥5-7 mm, and >7 mm stones, respectively [20]. Recently, McLarty et al [21] showed that the patients in the SSP group had smaller (5.4 vs. 7.6 mm) and more distal (71.4% vs. 34.6%) ureteral stones. Our results were consistent with previous studies, indicating that stone size was significantly lower in the SSP group (5.2 vs 6.7 mm).…”

Section: Discussionmentioning

confidence: 99%

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What is the role of inflammatory markers in predicting spontaneous ureteral stone passage?

Senel

Aykanat²,

Asfuroglu

et al. 2022

Aktuelle Urol

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Purpose: To investigate the role of inflammatory markers in predicting the spontaneous passage of ureteral stones. Methods: We retrospectively reviewed 279 patients with ureteral stones sized 4–10 mm that were managed conservatively. The patients were divided into two groups: Group 1 consisted of 137 patients who passed the stone spontaneously; Group 2 comprised 142 patients without spontaneous stone passage. The groups were compared using the Mann-Whitney U and chi-square tests. In addition, univariate and multivariate analyses were performed to identify the significance of the parameters. Results: The mean age of the patients was 41.2 years. The patients in Group 1 had a significantly lower mean stone size, white blood cell count and neutrophil count. In addition, stone location, presence of hydronephrosis and history of urolithiasis were significantly different between the groups. Neutrophil percentage, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were insignificantly lower in Group 1. In a multivariate analysis, stone size, distal location and hydronephrosis status significantly predicted the spontaneous stone passage. However, inflammatory markers including white blood cell count, neutrophil count and neutrophil-to-lymphocyte ratio could not determine the likelihood of spontaneous stone passage. Conclusion: Our results suggest that inflammatory markers are no meaningful parameters for the prediction of spontaneous stone passage.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

What is the role of inflammatory markers in predicting spontaneous ureteral stone passage?

Senel

Aykanat²,

Asfuroglu

et al. 2022

Aktuelle Urol

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“…Patient reported outcomes were used to predict spontaneous passage of ureteral calculi in this retrospective study of 212 patients by McLarty et al (page 524) from Canada. 3 Overall 49.5% successfully passed the stone, and stone size and distal ureteral location correlated with spontaneous passage. Of those with spontaneous passage 77% had cessation of pain compared to 44% without.…”

Section: Patient Reported Outcomes For Predicting Spontaneous Ureteral Stone Passagementioning

confidence: 86%

This Month in Adult Urology

Smith¹

2020

Journal of Urology

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“…Endpoint heterogeneity is a common obstacle in research evaluating MET as anything less than a study-end computed tomography appears to be inadequate. Studies in the adult literature have challenged the accuracy of patient selfreporting in assessing stone passage (21,22). More worrisome, secondary analysis of a multicenter prospective RCT investigating MET in adults reported over half of patients with a persistent ureteral stone showed resolution of hydronephrosis and reported no pain (23).…”

Section: Outcome-level Limitationsmentioning

confidence: 99%

Medical Expulsive Therapy (MET) for Ureteral Calculi in Children: Systematic Review and Meta-Analysis

et al. 2022

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BackgroundMedical expulsive therapy (MET) is the use of medication to facilitate ureteral stone passage prior to surgical intervention. Practice guidelines for the use of MET in the pediatric population remain limited, primarily due to a scarcity of randomized controlled trials and concerns regarding dosing and side effects. To address this, we conducted a systematic review and meta-analysis to clarify the impact of MET on the spontaneous passage of pediatric stones located within the distal ureter.MethodsA narrow scope search using PubMed and Embase with a predefined search strategy was performed in September 2021 to identify all randomized controlled trials involving the use of pediatric MET for stones located in the distal ureter. Raw data from 6 eligible articles were extracted for pooled analysis. Our primary outcome was the overall effect of MET on ureteral calculi passage within 28 days compared to controls.ResultsThe mean age of patients in included studies was 7.6 years-old, with a range of ages 2–18 years old. In the pooled analysis of eligible studies, 235 patients received MET and 176 received placebo. The mean stone size was 6.40 mm in the treatment arm and 6.42 mm in the control arm. Children receiving MET were more likely than controls to experience spontaneous stone passage [Relative risk 1.39 (CI 95% 1.21–1.60)]. Considering all included studies, only one child treated with MET withdrew due to medication side effects.ConclusionOur systematic review and meta-analysis of the use of pediatric MET on spontaneous distal ureteral stone passage demonstrates a statistically significant benefit. The benefits of MET are diverse and include, possibly, minimizing exposure to anesthesia and radiation alongside improving surgical outcomes if ureteroscopy must be performed. Given the increasing incidence of ureteral stones in children and the nuances inherent to pediatric surgery due to smaller anatomy, MET represents an opportunity for safer and more effective pediatric stone management.

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Patient Reported Outcomes Predicting Spontaneous Stone Passage May Not Have Acceptable Accuracy

Cited by 10 publications

References 0 publications

What is the role of inflammatory markers in predicting spontaneous ureteral stone passage?

What is the role of inflammatory markers in predicting spontaneous ureteral stone passage?

This Month in Adult Urology

Medical Expulsive Therapy (MET) for Ureteral Calculi in Children: Systematic Review and Meta-Analysis

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