Anuria Secondary to Bilateral Obstructing Ureteral Stones in the Absence of Renal Colic

Objective: Determine the relationship between clinical symptoms of colic pain and haematuria as a predictor of ureteral stones incident at Dr Soetomo Hospital within a period of five years. Material & methods: This study is a descriptive analytic study using the sensitivity-specificity test with retrospective design. Data were collected from patient's medical records with a ureteral stone diagnosis at outpatient unit Dr Soetomo Hospital within 2011-2015. Results: Renal colic or ureter colic without haematuria had 88.32% specificity and 53.07% sensitivity in the incidence of ureteral stones at Urology Outpatient Unit Dr Soetomo Hospital within 2011-2015 period. Haematuria without colic complaint had 29.37% sensitivity and 90.17% specificity in the incidence of ureteral stones. Colic and haematuria compared with colic had 55.76% sensitivity for the incidence of ureteral stones and 70.09% specificity. While colic and haematuria compared with haematuria had a sensitivity of 77.41% for the incidence of ureteral stones and 65.92% specificity. Colic and haematuria compared to other complaints has a 58.77% sensitivity for ureteral stones incidence and 94.66% specificity. Conclusion: Colic and haematuria are clinical predictors that have a better value than the complaints of colic without haematuria and haematuria without colic, in the ureteral stones incident at Urology Outpatient Unit Dr Soetomo Hospital within 2011-2015 period. This is consistent with the literature that mentions prominent complaint in the incidence of ureteral stones is their colic pain caused by the stone through the ureteral passage, and followed by haematuria for their mucosal surface injury.

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Findings of Non-enhanced Abdominal Computed Tomography for Pain Management of Acute Renal Colic Patients in the Emergency Department

10.22514/sv.2020.16.0056 ◽

2020 ◽

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Soft Tissue ◽

Renal Colic ◽

Repeated Administration ◽

Pain Medication ◽

Ureteral Stones ◽

Large Size ◽

Acute Renal Colic ◽

Enhanced Computed Tomography

Study Objectives: To identify non-enhanced computed tomography (NECT) findings related to repeated requirement of painkiller, hospitalization and revisits within 5 days of discharge among acute renal colic patients. Patients and methods: A retrospective observational study was performed for all patients (age > 18 years) with acute renal colic who visited the emergency department (ED) between 2012 and 2015. NECT findings of acute ureterolithiasis (size, location, hydronephroureter, perinephric infiltrations and soft-tissue rim sign) were analysed for their relationships to repeated administration of painkiller, hospitalization and ED revisit. Results: Of total 862 patients enrolled, 305 (35.4%) required repeated administration of pain medication. In the NECT findings, hydronephroureter was more prevalent in the repeated administration of painkiller group (61.3% vs. 53.7%), but did not show independent relationship. Sixty-eight (7.9%) were hospitalized and 44 (5.1%) returned to the ED. The significant findings associated with hospitalization were hydronephroureter (OR [Odd Ratio] 1.92, 95%CI [Confidence Intervals] 1.04–3.54) and mid (5–7 mm) / large-size (> 7mm) ureteral stones (OR 2.66, 95% CI 1.49–4.76 and OR 4.78, 95% CI 1.80–12.70). The soft-tissue rim signs (OR 2.16, 95%CI 1.07–4.37) and proximal/mid location of stones (OR 3.21, 95% CI 1.26–8.20 and OR 2.53, 95% CI 1.19–5.37) were independently associated with ED revisit. Conclusions: Among the NECT findings of acute ureterolithiasis, hydronephroureter and stones > 5 mm in size were independently associated with the need of hospitalization. The soft-tissue rim sign and proximal/mid location of stones were independently associated with ED revisit within 5 days.

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Re: Zhangqun Ye, Guohua Zeng, Huan Yang, et al. Efficacy and Safety of Tamsulosin in Medical Expulsive Therapy for Distal Ureteral Stones with Renal Colic: A Multicenter, Randomized, Double-blind, Placebo-controlled Trial. Eur Urol 2018;73:385–91

European Urology ◽

10.1016/j.eururo.2018.03.004 ◽

2018 ◽

Vol 74 (2) ◽

pp. e43-e44 ◽

Cited By ~ 1

Author(s):

Taimur T. Shah ◽

Graeme MacLennan ◽

Rob Pickard ◽

Samuel McClinton ◽

Veeru Kasivisvanathan

Keyword(s):

Renal Colic ◽

Controlled Trial ◽

Ureteral Stones ◽

Efficacy And Safety ◽

Double Blind ◽

Double Blind Placebo ◽

Medical Expulsive Therapy

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Ureterolitholapaxy: Our experience

Urologia Journal ◽

10.1177/039156039706400110 ◽

1997 ◽

Vol 64 (1) ◽

pp. 46-49

Author(s):

F. Cauda ◽

A. De Natale ◽

F. Alladio ◽

C. Ferraris ◽

U. Ferrando

Keyword(s):

Real Time ◽

Renal Colic ◽

Ureteral Stones ◽

Ureteral Lithiasis ◽

Highly Effective ◽

Endoscopic Lithotripsy ◽

Push Up

The authors report on their experience of treating ureteral stones in 1183 patients with ballistic and electrohydraulic endoscopic lithotripsy. Since the outcome was successful in 95% of cases with few complications (2%), this method is considered highly effective for treating stones in any part of the ureter, with the possibility of resolving renal colic in real-time. In the push-up cases (25% for sub-junctional ureteral lithiasis, 10% other sites) a second treatment was performed with ESWL after positioning a double J catheter.

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Ureteric stones

10.1093/med/9780199659579.003.0026 ◽

2017 ◽

Author(s):

Samarpit Rai ◽

Zachariah G. Goldsmith ◽

Michael E. Lipkin ◽

Glenn M. Preminger

Keyword(s):

Renal Colic ◽

The United States ◽

Primary Diagnosis ◽

Ureteral Stones ◽

Emergency Room Visits ◽

Narcotic Analgesics ◽

Acute Renal Colic ◽

Pharmacologic Management ◽

Year 2000 ◽

Targeted Approach

Acute renal colic is a common presentation to the emergency department. It is estimated that about 12% of men and 5% of women will have at least one symptomatic stone by the age of 70. Renal colic has an annual incidence 16 cases per 10,000 per year, and a lifetime incidence of 2–5%. In the year 2000, there were over 600,000 emergency room visits for urolithiasis listed as the primary diagnosis in the United States alone. In this chapter, acute pharmacologic management of patients diagnosed with ureteral stones will be outlined. The pharmacology and clinical efficacy for narcotic and non-narcotic analgesics will be reviewed. In addition, medical expulsive therapy using alpha blockers and other agents will be extensively reviewed, in order to provide a targeted approach to the pharmacologic management of patients diagnosed with acute renal colic secondary to a ureteral stone.

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Reply to the Reply to Andrew J. Portis and Matthew F. Bultitude's Letter to the Editor re: Zhangqun Ye, Guohua Zeng, Huan Yang, et al. Efficacy and Safety of Tamsulosin in Medical Expulsive Therapy for Distal Ureteral Stones with Renal Colic: A Multicenter, Randomized, Double-blind, Placebo-controlled Trial. Eur Urol 2018;73:385–91

European Urology ◽

10.1016/j.eururo.2018.04.013 ◽

2018 ◽

Vol 74 (2) ◽

pp. e42

Author(s):

Andrew J. Portis ◽

Matthew F. Bultitude

Keyword(s):

Renal Colic ◽

Controlled Trial ◽

Ureteral Stones ◽

Efficacy And Safety ◽

Double Blind ◽

Double Blind Placebo ◽

Medical Expulsive Therapy ◽

Letter To The Editor

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Distribution of ureteral stones and factors affecting their location and expulsion in patients with renal colic

Korean Journal of Urology ◽

10.4111/kju.2015.56.10.717 ◽

2015 ◽

Vol 56 (10) ◽

pp. 717 ◽

Cited By ~ 9

Author(s):

Young Joon Moon ◽

Hong-Wook Kim ◽

Jin Bum Kim ◽

Hyung Joon Kim ◽

Young-Seop Chang

Keyword(s):

Renal Colic ◽

Ureteral Stones ◽

Factors Affecting

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LO060: Diagnostic and prognostic value of hydronephrosis in emergency department patients with acute renal colic

CJEM ◽

10.1017/cem.2016.97 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S51-S51

Author(s):

G. Innes ◽

E. Grafstein ◽

A. McRae ◽

D. Wang ◽

E. Lang ◽

...

Keyword(s):

Prognostic Value ◽

Renal Colic ◽

Administrative Database ◽

Ureteral Stones ◽

Stone Size ◽

Early Management ◽

Predictive Values ◽

Surgical Interventions ◽

Index Visit ◽

Diagnostic And Prognostic Value

Introduction: Hydronephrosis is a marker of stone-related ureteral obstruction. Our objective was to assess the diagnostic and prognostic value of hydronephrosis in ED patients with renal colic. Methods: We used an administrative database to identify all renal colic patients seen in Calgary’s four EDs in 2014. Research assistants reviewed imaging reports to identify proven ureteral stones, and to document hydronephrosis and stone size. Surgical interventions, ED and hospital visits within 60-days were collated from all regional hospitals. The primary outcome was sensitivity and specificity of hydronephrosis (moderate or severe) for detecting stones >5mm. We also assessed the association of hydronephrosis with index admission-intervention, and with outcomes at 7 and 60 days. Results: In 2014, 1828 patients had a confirmed ureteral stone plus assessment of hydronephrosis and stone size (1714 CT, 114 US). Hydronephrosis was absent, mild, moderate or severe in 15%, 47%, 34% and 4% of patients respectively. Median stone size was 4.0, 4.0, 5.0 and 7.0mm for patients in these categories. Mild, moderate and severe hydronephrosis were highly associated with admission (OR=2.0, 4.6, 9.8; p<0.001) and index visit surgical intervention (OR=2.1, 3.7, 6.0; p<0.001). The presence of moderate-severe hydronephrosis was 54.7% sensitive and 65.4% specific for stones > 5mm, with positive and negative predictive values of 51% and 74.2%. Of 1828 patients, 748 had an index visit surgical procedure and 1080 were discharged with medical management. In the latter group, hydronephrosis was absent, mild, moderate or severe in 20%, 50%, 27% and 3%. Corresponding median (IQR) stone size was 3.0, 4.0, 4.0 and 5.0mm. Of 1080 medically managed patients, 19% and 25% had an unscheduled ED revisit by 14 and 60 days, 9% and 10% were hospitalized by 7 and 60 days, and 13% had a rescue procedure within 60 days. In the medically managed group, degree of hydronephrosis had no statistical association with any outcomes at 7 or 60 days. Conclusion: Hydronephrosis has poor sensitivity, specificity and predictive value for stones >5mm. Degree of hydronephrosis is highly associated with MD decisions for admission and intervention, but not associated with patient outcomes in the absence of these decisions. Despite poor diagnostic and prognostic performance, hydronephrosis is likely guiding critical early management decisions.

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