Expectant Management of Ureter Stones: Outcome and Clinical Factors of Spontaneous Passage in a Single Institution's Experience

Abstract

Purpose: The aim of this study was to evaluate the outcome of ureter stones with expectant management and the clinical factors associated with stone passage in Koreans.

Materials and methods: We reviewed the charts of patients who visited the emergency room or urological office of our institution with acute renal colic between 2001 and 2008. A total of 656 ureter stone formers were enrolled in this study who had decided to be treated by expectant management. Clinical data such as gender, age, size and location of the stone, body mass index, and previous stone history were analyzed to find the factors related to spontaneous passage of ureter stones.

Results: Of the 656 ureter stones, 566 stones (86.3%) were spontaneously expelled. Mean duration of follow-up was 17.5 days (range, 1 to 100 days). Mean time to stone passage was 6.8 days for stones less than 2 mm in size, 12.6 days for stones 2 to 4 mm, 14.8 days for stones 4 to 6 mm, and 21.8 days for stones 6 to 8 mm (p<0.001). The cumulative spontaneous passage rate was 55.3% in 7 days, 73.7% in 14 days, 88.5% in 28 days, and 97.7% in 60 days after the first attack. A total of 90 patients (13.7%) required interventions because of symptom relapse or renal deterioration that was related to the location and size of the stone (each, p<0.001). The more proximal the location and the larger the stone was than 6 mm, the less the chance of spontaneous passage (each, p<0.001).

Conclusions: Size and location of ureter stones are the most important factors for predicting the spontaneous passage of the stone. If a patient has a distal ureter stone of less than 6 mm in size, it is acceptable for the urologist to observe for spontaneous passage for 2 months.

Keywords: Ureteral calculi; Watchful waiting.

FIG. 1

Cumulative spontaneous passage rate during the follow-up periods in group 1.

FIG. 2

(A) Spontaneous stone passage rate between small-sized stones and large-sized stones during the observational periods. (B) Spontaneous stone passage rate between distal site stones and proximal site stones during the observational periods. (C) Comparison of spontaneous passage rate according to the size and site of the ureter stones.