ureteral stone
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Epidemiology
- male > female
- uncommon in blacks
Clinical manifestations
- acute onset of flank pain
- nausea/vomiting
Diagnostic criteria
Laboratory
Radiology
* patient-reported stone passage imperfectly predicts persistent stones on CT[6]
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]
More general terms
References
- ↑ 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24671981 <Internet> http://www.bmj.com/content/348/bmj.g2191
- ↑ 2.0 2.1 2.2 The Stone Score Table http://www.bmj.com/highwire/markup/691915/expansion?width=1000&height=500&iframe=true
- ↑ 3.0 3.1 3.2 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: https://www.ncbi.nlm.nih.gov/pubmed/27616037
- ↑ 4.0 4.1 Hollingsworth JM, Canales BK, Rogers MA et al Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. BMJ 2016;355:i6112 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27908918 <Internet> http://www.bmj.com/content/355/bmj.i6112
- ↑ 5.0 5.1 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/29913003 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2684476 - ↑ 6.0 6.1 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: https://www.ncbi.nlm.nih.gov/pubmed/31704458 https://www.goldjournal.net/article/S0090-4295(19)30930-6/fulltext
- ↑ 7.0 7.1 7.2 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: https://www.ncbi.nlm.nih.gov/pubmed/32716743 https://www.auajournals.org/doi/10.1097/JU.0000000000001318