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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]

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]

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]

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]

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]