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Background: Ureteric colic is a common emergency urological presentation [1]. When operative intervention is required, retrograde ureteroscopy is the most common approach. There are multiple treatment strategies including primary ureteroscopy (URS), staged ureteroscopy, and deferred ureteroscopy following ureteric stent placement. The approach is based on a number of clinical and stone factors. This study assesses the factors which predict stone clearance at the initial procedure. Aims: All patients diagnosed with an obstructing ureteric stone who were managed operatively in a consecutive 12-month period were included. Patients were evaluated for stone clearance following a single or multiple procedures. A number of factors including stone size, location, gender, age and pre-operative laboratory results were evaluated for association with stone clearance at index procedure. Multivariate logistic regression analyses were performed to produce odds ratios (OR) with confidence interval (CI) at 95% and significance values P < 0.05. Results: One hundred and seventy patients were included in the final analysis. Stone clearance following the index procedure was achieved in 57% (n = 100) of patients. Predictors of successful stone clearance at index procedure were stone size < 6 mm, male gender and distal stone location (p < 0.05). Proximal stone location, stone size > 10 mm and elevated c-reactive protein (CRP) were associated respectively with multiple procedures to achieve stone clearance (p < 0.05). Conclusions: Acute ureteric stones can be managed with a number of treatment strategies. This study identifies factors which predict stone clearance at index procedure. These results will help urologists accurately counsel patients when undertaking operative management for ureteric colic. [ABSTRACT FROM AUTHOR]

Objectives: Evaluation of safety, efficacy, and feasibility of emergency extracorporeal shockwave lithotripsy (eESWL) in combating obstructing stones with colic on emergency basis. Materials and methods: From November 2019 to November 2021, 102 subjects underwent emergency ESWL for obstructing ureteric and renal stones with colic within 24 h of presentation. Results: Patients in this study belonged to age group of 18–67 years with mean being 39 years consisting of 85 males and 22 females (M:F = 85:22). Mean stone dimensions were 8.26 mm in length and 7.65 mm in width. A total of 42 patients had their stone in kidney or upper ureter while 24 patients had stone in mid ureter and remaining patients (n = 36) had stone in lower ureter. About 65 patients had their stone completely cleared after single ESWL session while 20 patients required multiple sessions to achieve complete clearance. Of these 17 patients (16.67%) were not rendered stone free even after three sessions and had to undergo ureteroscopic lithotripsy (URSL). Overall Stone Free Rate (SFR) was 83.33%. For stone attenuation of ⩽900 HU, SFR was 97.18% while for >900 HU it was only 51.61%. Conclusion: eESWL is safe, feasible, and efficacious noninvasive alternative for definitive management of obstructing ureteral and renal stones with colic as far as stone clearance and rapid and definitive pain relief are concerned and that too with very minimal morbidity without the need for admission and hence can reduce the prolonged waiting period for endoscopic stone surgery in any high-volume tertiary care hospital. Length, width, and attenuation of stone were found to be the main factors dictating the success of eESWL. [ABSTRACT FROM AUTHOR]

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. Patients and Methods: A 2517 patient dataset was utilised from an international multicentre 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 UK, Ireland, Australia, and New Zealand. Inclusion criteria mandated a non‐contrast computed tomography of the kidneys, ureters, and bladder. SSP was defined as the 'absence of the need for intervention'. The model was developed using logistic regression and backwards selection (to achieve lowest Akaike's information criterion) 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%). The mean (SD) age was 47 (14.7) years and 1892 were male (75.2%). At the end of the modelling process, gender: male (odds ratio [OR] 0.8, 95% confidence interval [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 >5–7 mm (OR 0.2, 95% CI 0.16–0.25, P < 0.001), stone size >7 mm (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 nonsteroidal anti‐inflammatory drug (NSAID) use (OR 1.3, 95% CI 0.99–1.71, P = 0.06), and rectal NSAID use (OR 1.17, 95% CI 0.9–1.53, P = 0.24) remained. The 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 on‐line calculator via www.BURSTurology.com and could allow clinicians and patients to make a more informed decision on pursuing conservative management vs early intervention. [ABSTRACT FROM AUTHOR]

Background: Urolithiasis is a common urological presentation1. A total of 25–49 million people in Europe live with symptomatic stone disease, with the incidence increasing1. Aims: To examine length of stay (LOS) and transfer patterns for patients presenting with urolithiasis to Irish Model 2/3 hospitals without a specialist urology service, compared with those who present to a model 4 hospital with an on-site urology service. Methods: Using the National Quality Assurance & Improvement System (NQAIS), we assessed patients presenting with urolithiasis, nationally from January 2016 to December 2019. Results: During the study period, there were 11,856 emergency presentations with urolithiasis. A total of 6510 (54.9%) presented to model 4 hospitals, while 5346 (45.1%) presented to model 2/3 hospitals. A total of 874 (16.35%) patients required transfer from model 2/3 hospital to a model 4 hospital for further management. Those transferred from model 2/3 hospitals spent a mean of 3.68 days awaiting transfer and had a mean LOS of 3.88 days in the model 4 hospital. A total of 7.56 days compared with a mean LOS of 2.9 days for those presenting directly to a model 4 hospital. Conclusion: At a national level in Ireland, many patients with urolithiasis present to hospitals that are unable to cater for their needs. Patients presenting with urolithiasis to model 2/3 hospitals have significantly longer LOS compared with patients who present directly to a model 4 hospital. A formal 'stone pathway' is required to provide timely care for these patients2—such a pathway would provide better patient care and result in improved bed utilisation. [ABSTRACT FROM AUTHOR]

Objectives: To perform a systematic review to identify the clinical, fiscal and environmental evidence on the use of urological telehealth and/or virtual clinic (VC) strategies, and to highlight research gaps in this rapidly evolving field. Methods: Our PROSPERO‐registered (CRD42019151946) systematic search of Embase, Medline and the Cochrane Review Database was performed to identify original research articles pertaining to adult urology telehealth or VC strategies. Risk‐of‐bias (RoB) assessment was performed according to the Cochrane 2.0 RoB tool or the Joanna Briggs Institute Checklist for non‐randomized studies. Results: A total of 5813 participants were included from 18 original articles (two randomized controlled trials [RCTs], 10 prospective studies, six retrospective studies). Urology sub‐specialities comprised: uro‐oncology (n = 6); general urology (n = 8); endo‐urology (n = 2); and lower urinary tract symptoms and/or incontinence (n = 2). Across all sub‐specialties, prospective studies using VCs reported a primary median (interquartile range [IQR]) VC discharge rate of 16.6 (14.7–29.8)% and a primary median (IQR) face‐to‐face (FTF) clinic referral rate of 32.4 (15.5–53.3)%. Direct cost analysis demonstrated median (IQR) annual cost savings of £56 232 (£46 260–£61 116). Grade II and IIIb complications were reported in two acute ureteric colic studies, with rates of 0.20% (3/1534) and 0.13% (2/1534), respectively. The annual carbon footprint avoided ranged from 0.7 to 4.35 metric tonnes of CO2 emissions, depending on the mode of transport used. Patient satisfaction was inconsistently reported, and assessments lacked prospective evaluation using validated questionnaires. Conclusion: Urology VCs are a promising new platform which can offer clinical, financial and environmental benefits to support an increasing urological referral burden. Further prospective evidence is required across urological sub‐specialties to confirm equivalency and safety against traditional FTF assessment. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the clinical, fiscal and environmental impact of a specialist‐led acute ureteric colic virtual clinic (VC) pathway. Patients and Methods: All patients with uncomplicated acute ureteric colic, referred to a single tertiary centre, were prospectively entered into the study over a 4‐year period (January 2015–December 2018). Inclusion criteria were: low‐dose non‐contrast computed tomography of kidneys, ureters and bladder; white blood cell count <16 × 109/L; pain controlled; normal renal function; and no clinical concern. Primary outcomes were: time (days) from referral to VC outcome; VC outcome (discharge, further VC, face‐to‐face [FTF] clinic, extracorporeal shockwave lithotripsy [ESWL], ureterorenoscopy [URS], percutaneous nephrolithotomy [PCNL]); and adverse events (sepsis or obstruction). Secondary outcomes were patient and stone demographics, cost and environmental analysis. The minimum follow‐up was 3 months. Results: A total of 1008 patients entered the study, of whom 91.5% (n = 922) were of working age. The median (interquartile range) time from presentation to VC outcome was 2 (4) days. VC outcomes were as follows: 16.3% of patients (n = 164) were discharged; 18.2% (n = 183) were discharged after further VC; 17.2% (n = 173) underwent an intervention; and 48.4% (n = 488) were referred to an FTF clinic. Interventions comprised: PCNL 0.5% (n = 5); ESWL 7.7% (n = 78); and URS 8.9% (n = 90). Stone demographics were as follows: 570 patients (56.5%) had lower, 157 (15.6%) had upper, 96 (9.5%) had mid‐ureteric and 163 (16.2%) had renal calculi, and in 22 patients (2.2%) the stones had recently passed. The mean (sd) stone size was 3.5  (2.3) mm. Two adverse events (0.2%) were reported. Introducing a VC saved £145,152 for Clinical Commissioning Groups, the equivalent NHS tariff payment of performing 106 URS procedures or 211 ureteric stent insertions. Overall, 15,085 patient journey kilometres were avoided, equal to 0.70–2.93 metric tonnes of carbon dioxide equivalent production and the need to plant 14.7 trees to achieve carbon balance. Conclusion: A specialist‐led acute ureteric colic VC reduced time to treatment decision to a median of 2 days. This creates additional clinic capacity and reduces the fiscal burden of traditional clinics and their associated carbon footprint. [ABSTRACT FROM AUTHOR]

Purpose: Elderly patients with upper tract urothelial cancer (UTUC) may present with colic and microscopic haematuria, mimicking urolithiasis. Patients presenting to emergency departments with acute ureteric colic are investigated with a CT KUB. CT urography (CTU) identifies UTUC better than a CT KUB. Thus, there is a possibility that a CT KUB may miss UTUC.Methods: We studied patients aged 65 years or over presenting to the emergency department with ureteric colic and microscopic haematuria who had a CT KUB between January 2014 and October 2016. Patients who had both CT KUB and CTU were then compared to determine if CT KUB had missed a UTUC and if the diagnoses were concordant by the two tests. A radiologist independent from the reporting radiologists reviewed images as well as their reports. According to the Health Research Authority, England regulations, we did not obtain an ethical review on a voluntary basis for this retrospective study.Results: Four hundred eighty-five patients [228 (47.01%) male and 257 (52.99%) female] had a CT KUB scan over the 34-month period. Their mean age was 74 (SD 6.97) [males 73 (SD 6.42), females 75 (SD 7.42)] years. One hundred eighty-seven scans were normal. Ureteric calculi (167), renal calculi (58) and renal cysts (28) were most frequent diagnoses. The diagnosis was uncertain in 33 patients (6.8%) [16 (48.49%) males and 17 (51.51%) females]. The mean age of this group of patients was 74 (SD 6.64) [males 73 (SD4.43), females 74 (SD7.64)] years. These patients had a CTU for clarity. CTU identified one UTUC not identified by CT KUB (0.2%), corroborated the diagnosis of a ureteric tumour in one patient and excluded UTUC in two others. CTU diagnosed two new bladder tumours and an endometrial tumour. Diagnoses were concordant between CT KUB and CTU in 17 of 33 patients (51.5%).Conclusions: CT KUB scans for patients 65 years and over presenting with ureteric colic is justified. Only a small proportion of patients will subsequently require the higher radiation dose CTU as the probability of missing UTUC is low. [ABSTRACT FROM AUTHOR]

Background It has been reported that three criteria (size of calculus ≥6 mm, visual analogue scale pain score at discharge ≥2 cm and location above mid-ureter; the Papa criteria) were sensitive for predicting patients who require intervention (surgery or lithotripsy) within 28 days of index emergency department ( ED) visit for ureteric colic. It was suggested that absence of these criteria identified a group for whom early follow-up may not be needed. No validation has been reported. We aimed to validate these criteria. Methods Retrospective cohort study of patients with clinical presentation of ureteric colic and radiologically proven renal tract stones. Data collected included demographics, clinical features, features of the stone, imaging results and 28-day outcome. Outcome of interest was performance of the Papa criteria for prediction of urological intervention by clinical performance analysis. We also undertook a post hoc analysis to identify predictors of urological intervention for the group overall and for the subgroup discharged from ED. Results Two hundred and twenty-four patients were studied (median age 49, 79% male) with 75 (33%) requiring urological intervention within 28 days. The presence of any of the Papa criteria had sensitivity for urological intervention of 83.9% (95% confidence interval ( CI) 71.2-91.9%) with specificity of 47.7% (95% CI 38.9-56.6%), positive predictive value of 40.9% (95% CI 31.9-50.4%) and negative predictive value of 87.3% (95% CI 76.8-93.7%). Nine patients with no Papa criteria had intervention: 12.7% (95% CI 6.8-22.4%). Conclusion The Papa criteria are not sufficiently accurate to determine which patients require intervention or a subgroup who do not need specialist urological follow-up. [ABSTRACT FROM AUTHOR]

Ureteric colic is a common presentation to acute emergency services. The gold standard test for the diagnosis of acute ureteric colic is a non-contrast computer tomography of the kidneys ureters and bladder (CT KUB). Non-steroidal anti-inflammatory drugs (NSAIDs) should be used as first-line analgesia, with studies showing that there is no role for steroid or phosphodiesterase-5 inhibitors. There is emerging evidence that a high body mass index (BMI) is a risk factor. The drugs used to facilitate stone passage are known as medical expulsive therapy (MET). The most evaluated being alpha-blockers. The Spontaneous Urinary Stone Passage Enabled by Drugs (SUSPEND) trial was designed to evaluate the use of MET (tamsulosin and nifedipine). This trial showed that there was no difference with MET and placebo for the spontaneous passage of ureteric stones. There is an emerging role for the use of primary ureteroscopy in the management of non-infective ureteric stones. [ABSTRACT FROM AUTHOR]

The article presents a study which analyses the role of emergency ureteroscopy (URS) in the management of ureteric stones among 394 patients who underwent URS at Auckland City Hospital in Auckland, New Zealand between January 2010-December 2011. The study suggests that emergency URS is a feasible approach for the management of ureteric stones with low complications rate, particularly in younger, healthier patients.

Most ureteral stones can be observed with reasonable expectation of uneventful stone passage. When an active ureteral stone treatment is warranted, the best procedure to choose is dependent on several factors, besides stone size and location, including operators. experience, patients. preference, available equipment and related costs. Placement of double-J stent or nephrostomy tube represents the classical procedures performed in a renal colic due to acute ureteral obstruction when the conservative drug therapy does not resolve the symptoms. These maneuvers are usually followed by ureteroscopy or extracorporeal shockwave lithotripsy, which currently represent the mainstay of treatment for ureteral stones. In this review paper a literature search was performed to identify reports dealing with emergency management of renal colic due to ureteral stones. The main aspects related to this debated issue are analyzed and the advantages and disadvantages of each treatment option are carefully discussed. [ABSTRACT FROM AUTHOR]

SUMMARY Non-contrast enhanced helical CT has become an accepted technique for evaluating acute ureteric colic. The results of a randomized prospective comparison of the accuracy, cost and radiation dose of CT and intravenous urography (IVU) are presented. All patients presenting to the Emergency Department with symptoms and signs suggestive of ureteric colic over a 16-month period (n = 242) were randomized to CT or IVU. Follow up was obtained for 228 patients (94%), with 14 patients (6%) lost to follow up. One hundred and twenty-three patients (54%) underwent CT and 105 (46%) had an IVU. At follow up the sensitivity and specificity of CT were each 100%, while those of IVU were 99% and 100%, respectively. Computed tomography demonstrated seven of 26 (27%) potential alternative diagnoses, whereas IVU suggested one of 23 (4%). Estimates of the average effective dose were calculated for CT (4.95 mSv) and IVU (1.48 mSv, 95% confidence interval (CI) 0.7–2.27). Radiation dose and intravenous contrast material safety are discussed and the relative costs are considered. Computed tomography is as accurate as IVU in the diagnosis of acute ureteric colic. It confers certain major diagnostic benefits, and is a fast, well-tolerated technique. Its accompanying higher effective radiation dose is recognized. [ABSTRACT FROM AUTHOR]

Abstract Objectives: 1. To investigate the diagnostic accuracy of urinalysis and the plain abdominal radiograph in predicting positive intravenous pyelography for patients with a history and examination suggestive of ureteric colic. 2. To examine the disposition of patients presenting to the emergency department with ureteric colic. Methods: A retrospective cohort study set in a tertiary referral hospital emergency department over a 12-month period was conducted. Three hundred and eighteen patients who presented with a provisional diagnosis of ureteric colic and had intravenous pyelography were identified from radiology department logs and emergency department discharge International Classification of Disease-9 codes. Results: Three hundred and eighteen patients were identified. Sixty-nine per cent had positive intravenous pyelography. Sensitivity and specificity of: urinalysis were 93% and 41%; abdominal X-ray, 57% and 83%; and urinalysis plus abdominal X-ray, 99% and 36%, respectively. Seventy-seven per cent were admitted to the emergency department observation ward. Twenty-seven per cent were subsequently admitted under the hospital’s urology service. Conclusions: Sex, haematuria and the presence of a calculus on abdominal X-ray were all significant predictors of positive intravenous pyelography. Haematuria was sensitive but not specific for positive intravenous pyelography. The addition of the abdominal X-ray marginally improves the diagnostic accuracy. [ABSTRACT FROM AUTHOR]

A randomized, double-blind, multicentre clinical trial was designed to compared the analgesic efficacy of i.m. dipyrone 1 and 2 g, i.m. diclofenac sodium and i.m. pethidine in acute renal colic. The study was carried out in 451 patients in 13 Spanish hospitals. Ureteric colic was diagnosed by the clinical features, urinalysis, or when the presence of a ureteric calculus was confirmed. The severity of pain was assessed by the physicians and by patients using visual analogue scales. The main parameter of drug efficacy was the need for rescue treatment-pethidine 100 mg i.m. 30 min after the experimental treatment. Rescue treatment was required in 93 patients: they represented 24.1% of the group given dipyrone 1 g; 22.3% of those on dipyrone 2 g; 16.4% of those given diclofenac sodium; and 19.5% of those on pethidine. The differences between the groups were not significant. In the remaining 358 patients, no difference between treatments was observed. The results suggest that in acute renal colic the use of dipyrone 2 g is unjustified as dipyrone 1 g is equally effective. Diclofenac sodium is a valid alternative, which shows similar analgesic efficacy. [ABSTRACT FROM AUTHOR]

In a double-blind, double-dummy randomized controlled clinical trial, the onset and duration of the analgesic effect of dipyrone, 1 or 2 g, and diclofenac sodium, 75 mg, by either the i.m. or the i.v. route were compared in 293 patients (aged 18-70 years) with acute renal colic. A level of ≥ 50 mm on the 100-mm visual analogue scale was required for inclusion in the study. Patients were randomly allocated to six treatment groups, receiving dipyrone 1 g i.m., dipyrone 1 g i.v., dipyrone 2 g i.m., dipyrone 2 g i.v., diclofenac sodium 75 mg i.m.; and diclofenac sodium 75 mg i.v, respectively. Evaluations were performed at 10, 20, 30, and 60 min and 2, 4, and 6 h after treatment (time 0). Primary efficacy end points included course of pain, total pain, percentage of patients with a pain improvement of 50% or more at each evaluation time, pain intensity evaluated by the investigator on a 0-3 scale, and differences in pain intensity. The analgesic response was more marked and prolonged among patients receiving dipyrone 2 g i.m. or dipyrone 2 g i.v. There were no significant differences between dipyrone 1 g and diclofenac sodium 75 mg, by either the i.m. or the i.v. route. All treatment regimens were well tolerated. [ABSTRACT FROM AUTHOR]

Implantation of a stone in the ureter of the dog by ureterotomy results in focal hyperperistalsis which is accentuated by administration of norepinephrine, and reduced by administration of phenoxybenzamine or isoproterenol. Administration of dipyrone reduces the hyperperistalsis, but this action does not appear to be that of either a β-agonist or an α-antagonist. [ABSTRACT FROM AUTHOR]

A randomised prospective double-blind study of the effect of 1 mg glucagon intravenously was done on 51 consecutive patients with acute uretic colic. No significant difference between glucagon and placebo could be demonstrated as to pain relief or passage of calculi. [ABSTRACT FROM AUTHOR]

Abstract The aim of this study was to compare non-enhanced spiral CT (NECT) and intravenous pyelography (IVP) in patients with suspected acute renal colic. Two-hundred patients presenting to the Emergency Department with suspected acute renal colic were randomized into groups undergoing NECT or IVP. The main outcome measures were diagnostic utility, incidence of alternative diagnoses, requirement for further imaging, length of hospital stay, urological intervention rates, radiation dosage and costs. Non-enhanced spiral CT was better than IVP in making a definitive diagnosis of ureteric calculus or of recent calculus passage (65/102 or 66% vs 42/98 or 41%; P = 0.003). Calculi were missed in two patients in the IVP group. Two patients in each group had alternative diagnoses by initial imaging. There was no difference in the length of hospital stay or intervention rate. More plain X-rays during admission and more IVPs during follow up were performed in the NECT group. Effective radiation dosages were 2.97 mSv (IVP) and up to 5 mSv (NECT). Non-enhanced spiral CT provided greater diagnostic utility in this randomized comparison but no difference in measured outcomes. The incidence of alternative diagnoses was low, probably due to patient selection. Financial costs for each modality are comparable in a public tertiary hospital. Radiation dosages are higher for NECT and, for this reason, it might be appropriate to consider limiting NECT use to patients who have do not have classical symptoms of renal colic, to older patients and those with a contraindication to the administration of intravenous contrast media. [ABSTRACT FROM AUTHOR]