Clinical and Radiological Predictors of Early Intervention in Acute Ureteral Colic

Faris Abushamma; Mahfouz Ktaifan; Abdoh Abdallah; Mohammad Alkarajeh; Mosab Maree; Ahmed Awadghanem; Ahmad Jaradat; Amir Aghbar; Sa'ed H Zyoud; Francis X Keeley Jr

doi:10.2147/IJGM.S322170

Clinical and Radiological Predictors of Early Intervention in Acute Ureteral Colic

Int J Gen Med. 2021 Jul 30:14:4051-4059. doi: 10.2147/IJGM.S322170. eCollection 2021.

Authors

Faris Abushamma^{1

2}, Mahfouz Ktaifan¹, Abdoh Abdallah¹, Mohammad Alkarajeh¹, Mosab Maree^{1

3}, Ahmed Awadghanem^{1

3}, Ahmad Jaradat^{1

2}, Amir Aghbar^{1

2}, Sa'ed H Zyoud^{4

5}, Francis X Keeley Jr⁶

Affiliations

¹ Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
² Department of Urology, An-Najah National University Hospital, Nablus, 44839, Palestine.
³ Department of Radiology, An-Najah National University Hospital, Nablus, 44839, Palestine.
⁴ Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
⁵ Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine.
⁶ Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK.

Abstract

Purpose: Acute ureteric colic (AUC) is generally one of the most common reasons for emergency department attendance. Expectant management is recommended in non-complicated ureteral calculi. However, data regarding the optimal duration of observation or indications of early intervention (EI) are not well understood. This article describes the clinical and radiological factors that promote EI in AUC.

Patients and methods: This was an observational and retrospective cohort study. Patients with AUC diagnosed based on non-contrast computerized tomography (NCCT) between 2019 and 2020 were enrolled in the study. These patients were classified into two main categories: spontaneous passage of stone (SSP) and EI. In addition, a comparative analysis was performed to identify clinical and radiological variables that promote EI.

Results: One-hundred and sixty-one patients were included. High WBCs are associated with a significant increase in EI. Forty-three percent (n=37) of patients with serum WBCs higher than 10 had an EI, while 23% had SSP (n=17;p<0.001). High CRP level is also significantly associated with EI (n=36; 86%; p<0.001). Upper and middle ureteral calculi are statistically associated with EI (n=54; 62%) in comparison to the SSP cohort (n=22; 30%;p<0.001). EI is also linked to the maximal length of ureteric calculi (MCL) of 9 mm (6-13mm), and HU density of stone of 700 (430-990) H.U (p<0.001). Ureteric stone volume of 0.2 (0.06-0.3) cm³ is significantly associated with EI (p<0.001). Ureteral wall thickness of 3 (2-3 mm), the presence of extrarenal pelvis (n=20; 23%), and AP diameter of renal pelvis 18 (13-28 mm) are all significantly associated with a higher rate of EI (p<0.001). Multiple binary logistic regression analysis showed that MCL is the strongest predictor of EI.

Conclusion: MCL is an independent and robust predictor of EI in AUC. Biochemical variables and radiological characteristics can also act as an adjunct to promote EI.

Keywords: maximal length of ureteral calculi; medical expulsive therapy; pyonephrosis; spontaneous stone passage; ureteral calculi.

Grants and funding

No specific grant was received from any public, commercial, or non-profit funding agency for this research.