The role of serum acute phase reactant level at prediction of impacted ureteral stone

Abstract

The role of serum acute phase reactant levels in the prediction of impacted ureteral stone U rolithiasis is a disease that affects between 4% and 15% of the world population and the rate continues to grow [1]. Some 86% to 97% of ureteral stones are smaller than 3 mm in size and are passed spontaneously without any symptoms or medical treatment. Larger stones, on the other hand, cause dilatation of the ureter through partial or whole acute obstruction, depending on the size and location. Furthermore, they can cause colic pain through smooth muscle and epithelial reactions [2]. An impacted ureteral stone is defined as a case in which the stone remains in the ureter for more than 2 months in the same position and a guidewire cannot be passed endoscopically to the proximal side of the stone [3, 4]. An impacted stone can lead to local inflammatory reactions as a result of remaining in the same place in the ureter for an ex-Objectives: The aim of this study was to investigate the determination of ureteral stone impaction using acute phase reactants. Methods: A total of 110 patients who had a single ureteral stone treated during a single month using medical expulsive therapy of tamsulosin 0.4 mg/day, diclofenac 75 mg upon analgesic requirement, and at least 3 liters fluid per day were evaluated prospectively. The patients underwent ureteroscopy and were divided into 2 groups according to the presence or absence of impaction. The preoperative white blood cell (WBC) count, red blood cell distribution width (RDW), C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), mean platelet volume (MPV), and neutrophil-tolymphocyte ratio (NLR) in the non-impacted stone group (Group 1; n=59) and the impacted group (Group 2; n=51) were statistically compared. Results: There was no statistically significant difference in terms of age, stone diameter, body mass index, grade of hydronephrosis, or stone localization between the 2 groups. The WBC, RDW, and MPV value differences were statistically significant between the groups (p=0.035, p=0.035, and p=0.005, respectively). An MPV cutoff value of 9.55 fL was defined in Group 2 with 66% sensitivity and 62% specificity for impaction. There was no statistically significant difference between the groups in CRP, ESR, or NLR values (p=0.44, p=0.76, p=0.54, respectively). Conclusion: Evaluation of serum MPV with a cutoff value of 9.55 fL may predict ureteral stone impaction.