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ureteral stone

Epidemiology: - male > female - uncommon in blacks Clinical manifestations: - acute onset of flank pain - nausea/vomiting Laboratory: - urinalysis: microscopic hematuria Radiology: - computed tomography (CT)* - ultrasonography * patient-reported stone passage imperfectly predicts persistent stones on CT [6] Diagnostic criteria: - Stone score may eliminate need for CT [2] - see Stone score [2] Management: - also see urinary calculus - tamsulosin 0.4 mg QD for patients with renal colic & ureteral stone 4-10 mm in size [3] - NNT = 5 to expedite passage of 1 stone [3] - passage rate 76% with tamsulosin, 48% without [4] - tamsulosin of no benefit for passage of stones < 9 mm [5] - 28 days of tamsulosin - prognosis: - most stones pass spontaneously - spontaneous passage 90%, 65%, & 41% i patients with stone size of < 5 mm, 5-7 mm, > 7 mm respectively [7] - probability of spontaneous stone passage high when stone is in distal urethra vs proximal urethra - for stone > 10 mm or not passinv spontaneously or with tamsulosin - ureteroscopy with basketing or lithotripsy [7]

General

urinary calculus (stone, nephrolithiasis, urolithiasis) ureteral disease

References

  1. Moore CL et al Derivation and validation of a clinical prediction rule for uncomplicated ureteral stone - the STONE score: retrospective and prospective observational cohort studies. BMJ 2014;348:g2191 PMID: 24671981 http://www.bmj.com/content/348/bmj.g2191
  2. The Stone Score Table http://www.bmj.com/highwire/markup/691915/expansion?width=1000&height=500&iframe=true
  3. Wang RC, Smith-Bindman R, Whitaker E et al. Effect of tamsulosin on stone passage for ureteral stones: A systematic review and meta-analysis. Ann Emerg Med 2016 Sep 8; PMID: 27616037
  4. Hollingsworth JM, Canales BK, Rogers MA et al Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. BMJ 2016;355:i6112 PMID: 27908918 http://www.bmj.com/content/355/bmj.i6112
  5. Meltzer AC, Burrows PK, Wolfson AB et al Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones. A Randomized Clinical Trial. JAMA Intern Med. Published online June 18, 2018 PMID: 29913020 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2684477 - Dahm P, Hollingsworth JM Medical Expulsive Therapy for Ureteral Stones - Stone Age Medicine. JAMA Intern Med. Published online June 18, 2018 PMID: 29913003 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2684476
  6. Meltzer AC, Burrows PK, Kirkali Z et al. Accuracy of patient reported stone passage for patients with acute renal colic treated in the emergency department. Urology 2020 Feb; 136:70 PMID: 31704458 https://www.goldjournal.net/article/S0090-4295(19)30930-6/fulltext
  7. Innes GD, Scheuermeyer FX, McRae AD et al. Which patients should have early surgical intervention for acute ureteral colic? J Urol 2021 Jan; 205:152. PMID: 32716743 https://www.auajournals.org/doi/10.1097/JU.0000000000001318