Nomogram predicting the probability of spontaneous stone passage in patients presenting with acute ureteric colic

Chuanyu Gao; Max Peters; Piet Kurver; Thineskrishna Anbarasan; Keerthanaa Jayaraajan; Todd Manning; Sophia Cashman; Arjun Nambiar; Marcus Cumberbatch; Benjamin W Lamb; Robert Pickard; Paul Erotocritou; Daron Smith; Veeru Kasivisvanathan; Taimur T Shah; BURST Collaborative MIMIC Study Group

doi:10.1111/bju.15839

Nomogram predicting the probability of spontaneous stone passage in patients presenting with acute ureteric colic

BJU Int. 2022 Jun 28;130(6):823-831. doi: 10.1111/bju.15839. Online ahead of print.

Authors

Chuanyu Gao¹, Max Peters², Piet Kurver², Thineskrishna Anbarasan¹, Keerthanaa Jayaraajan¹, Todd Manning³, Sophia Cashman¹, Arjun Nambiar¹, Marcus Cumberbatch^{1

4}, Benjamin W Lamb^{1

5}, Robert Pickard⁶, Paul Erotocritou⁷, Daron Smith⁸, Veeru Kasivisvanathan^{1

9}, Taimur T Shah^{1

9

10

11}; BURST Collaborative MIMIC Study Group

Collaborators

BURST Collaborative MIMIC Study Group:
H Abboudi, H Abdelmoteleb, M Abu Yousif, P Acher, R Adams, M Ager, I Ahmed, L Ajayi, A Akintimehin, J Akman, S Al Hayek, W Al-Dhahir, Z Al-Qassim, S Al-Shakhshir, M Alberto, C Ali Abdaal, M Arya, N Assaf, B Ayres, H Badgery, K Bateman, A Bdesha, N Bedi, R Begum, M Belal, C S Biyani, D Bolton, M Bultitude, F Burge, J Bycroft, F Cameron, A Campbell, A Cannon, A Carrie, B Chappell, Aol Chin, K Chow, D Christidis, J Clements, J Coode-Bate, P Cronbach, D Curry, R Dasgupta, S Demirel, L Derbyshire, W Din, E Docherty, E Edison, D Eldred-Evans, G Ellis, S Evans, R Foley, R Frymann, M Gallagher, B Gowardhan, J Graham, S Graham, S Gray, P Grice, S Gupta, S Hamad, G Hann, A Harris, E Hatem, A Hawary, Z Hayat, D Hayne, M Hegazy, J Henderson, J Hendry, C Ho, A Hughes-Hallet, A Hussain, Z Hussain, H Ibrahim, S Irving, N Ivin, A Jaffer, R Jalil, F Kashora, R Kavia, L Kerr, S Khadouri, A Khan, M Khan, S Khan, S Koschel, A A Kozan, F Kum, H Kynaston, A Laird, L Lavan, N Lawrentschuk, Jcm Lee, S Lee, M Liew, K Mackenzie, M Malki, D Manson-Bahr, H Mason, M Matanhelia, J Maw, J Mbuvi, N Mc Cauley, S Mc Grath, A C Mc Kay, C Mcilhenny, I Miakhil, M Miller, A B Mirza, V Morrison-Jones, J Morrow, R Mosey, K Murtagh, M Natarajan, Y Nehikhare, D Ness, A Ng, S Ngweso, N Nkwam, M Nyandoro, T Nzenza, J O' Brien, J O' Rourke, J O' Brien, P Olaniyi, J Olivier, B Osman, A Oyekan, K Pang, R Pankhania, I Parwaiz, B Parys, J Patterson, I Pearce, S Phipps, Y Premakumar, J L Probert, D Quinlan, H Ratan, K Reid, M Rezacova, S Rezvani, F Rodger, A Rogers, D Ross, C Rowbotham, P Rujancich, P Ruljancich, I Sadien, A Sakthivel, A Saleemi, A Samsudin, S Sandhu, L Seaward, A Sharma, S Sharma, I Shergill, A Shetty, C Shingles, L Simmons, R Simpson, N Simson, H Singh, D Smith, S Sriprasad, R Stammeijer, C Steen, H Stewart, T Stonier, L Suraparaj, D Swallow, A Symes, R Symes, K Tailor, C Tait, J P Tam, J Tay, L J Tay, R Tregunna, E Tudor, C Udovichich, N Umez-Eronini, L Wang, A Ward, G Weeratunga, J Withington, C Wong, S Wozniak, O Yassaie, M Young

Affiliations

¹ British Urology Researchers in Surgical Training (BURST), London, United Kingdom.
² Department of Radiation Oncology, Cancer Centre, University Medical Centre Utrecht.
³ Australian Young Urology Researchers Organisation (YURO), Australia.
⁴ Academic Urology Unit, University of Sheffield, UK.
⁵ Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁶ Newcastle University, Dept. of Urology, Newcastle, United Kingdom.
⁷ Whittington Hospital, Dept. of Urology, London, United Kingdom.
⁸ University College London Hospital, Dept. of Urology, London, United Kingdom.
⁹ University College London, Division of Surgery, and Interventional Science.
¹⁰ Imperial College London, Division of Surgery and Cancer, London, United Kingdom.
¹¹ Charing Cross Hospital, Imperial Health NHS Trust, London, United Kingdom.

Abstract

Objectives: To develop a nomogram that could predict spontaneous stone passage (SSP) in patients presenting with acute ureteric colic who are suitable for conservative management.

Subject/patients: A 2517 patient dataset was utilised from an international multi-centre cohort study (MIMIC, A Multi-centre Cohort Study Evaluating the role of Inflammatory Markers In Patients Presenting with Acute Ureteric Colic) of patients presenting with acute ureteric colic across 71 secondary care hospitals in the United Kingdom, Ireland, Australia, and New Zealand. Inclusion criteria mandated a non-contrast CT-KUB.

Methods: SSP was defined as the 'absence of the need for intervention'. The model was developed using logistic regression and backwards selection (to achieve lowest AIC) in a subset from 2009-2015 (n=1728) and temporally validated on a subset from 2016-2017 (n=789).

Results: Of the 2517 patients, 1874 had SSP (74.5%). Mean age (±[SD]) was 47 (±14.7) years and 1892 were male (75.2%). At the end of the modelling process, gender: male (OR 0.8, 95%CI 0.64-1.01, p=0.07), neutrophil count (OR 1.03, 95%CI 1.00-1.06, p = 0.08), hydronephrosis (OR 0.79, 95%CI 0.59-1.05, p=0.1), hydroureter (OR 1.3, 95%CI 0.97-1.75, p =0.08), stone size >5-7mm (OR 0.2, 95%CI 0.16-0.25, p<0.0001), stone size >7mm (OR 0.11, 95%CI 0.08-0.15, p<0.001), middle ureter stone position (OR 0.59, 95%CI 0.43-0.81, p=0.001), upper ureter stone position (OR 0.31, 95%CI 0.25-0.39, p<0.001) ), medical expulsive therapy use (OR 1.36, 95%CI 1.1 - 1.67, p = 0.001), oral NSAID use (OR 1.3, 95%CI 0.99 - 1.71, p=0.06), and rectal NSAID use (OR1.17, 95%CI 0.9 - 1.53, p=0.24) remained. Concordance-statistic (C-statistic) was 0.77 (95%CI 0.75 - 0.80) and a nomogram was developed based on these.

Conclusion: The presented nomogram is available to use as an online calculator via www.BURSTurology.com and could allow clinicians and patients to make a more informed decision on pursuing conservative management versus early intervention.

Keywords: Ureteric colic; multivariable; normogram; predict; spontaneous stone passage.