For patients presenting with acute ureteral colic, stone size and location should guide the decision to allow a trial of spontaneous passage or provide early surgery, according to Bryce Weber, MD, of the University of Calgary in Alberta, and colleagues. The team presented new study findings Sunday at the Canadian Urological Association 74th annual meeting in Quebec City.

Of 3081 patients seen at emergency departments in Calgary and Vancouver, 1168 (37.9%) underwent surgical intervention within 3 days and 1913 (62.0%) had a trial of spontaneous passage for at least 5 days. For patients to be eligible for the study, computed tomography had to confirm a stone size of 2.0 to 9.9 mm in diameter.

In patients attempting spontaneous passage, adverse outcomes such as pain increased proportionally with increasing stone width and more proximal stone location. Patients who underwent early surgical intervention fared similarly regardless of stone size, but had worse outcomes with proximally located stones.

The data suggest that patients with low-risk stones less than 5 mm wide undergo a trial of spontaneous passage, according to the investigators. Patients with high-risk stones wider than 7.0 mm or wider than 5 mm located in the proximal-middle ureter should be offered early surgery. Medium-risk stones, defined as distal stones wider than 5.0 mm, should be managed on a case-by-case basis.

“This study provides strong evidence for specific stone parameters to guide early intervention in patients presenting with ureteral colic,” Dr Weber and colleagues concluded in a study abstract. “These recommendations are more aggressive than current American guidelines, which recommend a trial of spontaneous passage at <10 mm.”

Reference

Innes G, Carlson K, Andruchow J, et al. Outcomes of surgical vs. medical management in emergency departments for acute ureteral colic. Presented at the 2019 Canadian Urological Association 74th annual meeting held June 29-July 1 in Quebec City. Abstract UP-3.2.