Indicators that can be used to predict the spontaneous passage of ureter stones

Introduction and Purpose Urolithiasis is a common health problem with a high recurrence rate, and poor management of the balance of follow-up and intervention may lead to undesirable consequences ranging from urinary tract infection to sudden deterioration in renal function. Therefore, early determination of the possibility of spontaneous passage (SP) of a stone in the ureter will ensure patient safety by preventing a uroseptic situation that may develop in a case without SP and reduce the complications and financial burden of aggressive early intervention for treatment in a case with SP. In this context, the aim of this study was to identify some criteria that may predict the possibility of SP of a stone in the ureter. Materials and Methods Between January 1, 2019 and December 31, 2023, 2773 patients admitted to the emergency department and/or urology departments of Erzincan Binali Yıldırım University Mengücek Gazi Training and Research Hospital after renal colic attack were retrospectively reviewed. After applying various exclusion criteria, a total of 897 patients with unilateral ureteral stones less than 10 mm in diameter diagnosed by computed tomography (CT) with non-contrast stone protocol, and with inflammatory serum markers investigated by biochemical tests were included in the study without any age limit. The size of the stone, lateralization of the stone, localization of the stone, ureteral wall thickness (UWT) at the level of the stone, stone density, degree of hydronephrosis (HN), ureteral length, parenchymal thickness and density were measured by non-contrast CT scan, and neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) were determined by biochemical tests and the effect of these parameters on the prediction of SP of ureteral calculi was investigated. xiii Results The study population consisted of a total of 897 patients, 513 of whom had no SP of the ureteral stone. In this study, it was determined that, apart from the frequently used criteria of high stone size (right >6.5 mm, left >6 mm) and proximal stone location, high stone density (>957 HU), increased ureteral wall thickness (>1.7 mm), presence of high-degree hydronephrosis proximal to the stone (grade ≥ 2) and increased NLR (>2.15) and TLR (>10.28) values in blood were inversely proportional to the probability of SP of the stone. In addition, the relationship between the defined criteria and SP of the stone was determined with logistic regression analysis tests the predictive values were found to be statistically significant. It was observed that ureter length, renal parenchymal thickness and renal parenchymal density were not statistically significantly associated with SP of ureteral stone. In our study, it was observed that the SP of the stone decreased by 7,046 times above the cut-off values of 6-6.5 mm determined for the size of the stone, which was also included in the guidelines in shaping the treatment protocol of ureteral stones. It has been shown that SP of ureteral stone decreases by 706,500 times if it is above the 1.7 mm cut-off value determined for UWT at the level of ureteral stone, which is not yet included in the guidelines. Conclusion In conclusion, determining the criteria and standardized measurement values that will help us predict the likelihood of stone-related SD in cases of urolithiasis, which remains a debated issue, will contribute to both patient health and the reduction of the increasingly frequent financial burden. In our study, it was demonstrated that the increased stone size and high-placed stone localization in the SD of the producer stones, along with the increase in UDK at the stone level, high stone density, the presence of high-grade HN, and the inflammatory markers NLO and TLO reaching high levels in the blood could be used as criteria.