Influence of Geometric Characteristics of Ureteral Calculi on Their Spontaneous Elimination

4Yu.V. Roshchin

Abstract


The aim of our study was to determine the effect of the geometric characteristics of the stone and its location in the ureter on the effectiveness of conservative therapy. We studied 1,000 patients receiving conservative therapy for ureteral calculi. The analysis showed that 813 (81.3 %) patients completed the treatment of spontaneous elimination of the stone, while for 187 (18.7 %) patients the conservative treatment was ineffective. One of the key features defining the prognosis of spontaneous elimination of stones is the size of the stone. The average stone size in the group with effective treatment was 4.89 ± 0.04 mm and in the group with the lack of effect it was 7 (3.7 ± 1.4 %) mm (p < 0.001). There were veraciously more patients with successful result of conservative treatment with stones of 4 and 5 mm — 213 (26.2 ± 1.5 %) and 231 (28.4 ± 1.6 %) patients, respectively. In the group with the absence of spontaneous discharge there were 25 (13.4 ± 2.5 %) (p < 0.001) and 33 (17.6 ± 2.8 %) (p < 0.001) patients with the same stone dimensions, respectively. As the size of the stone increased up to 6 and 7 mm we noted a significant increase in the number of patients with ineffective treatment 73 (39.0 ± 3.6 %) and 46 (24.6 ± 3.2 %) respectively against 178 (21.9 ± ± 1.5 %) (p < 0.001) and 82 (10.1 ± 1.1 %) (p < 0.001) in the group of spontaneous elimination of stones. The stones up to 5 mm show the highest probability of spontaneous elimination. When analyzing the geometric characteristics of the stone in patients with ureterolithiasis we have identified three main shapes of stones: spherical, oval and polygonal.
Sign of the spherical shape of the stone appears more frequently in the group with spontaneous elimination of stones for 181 (22.3 ± 1.5 %) patients compared to 29 patients (15.5 ± 2.7 %) in the group with the absence of spontaneous passage. Diametrically opposite trend was found for stones with an oval shape: in the group with spontaneous elimination of stones there were identified 326 (40.96 ± 1.64 %) patients and in the group with ineffective treatment 95 (51.92 ± ± 4.92 %). It should be noted that in the first and in the second case quite weak (p < 0.05) confidence differences were revealed, this can not be said about the stones with a polygonal shape, where p < 0.001 (3 (0.4 ± 0.2 %) patients in the group with spontaneous elimination of stones against 10 (5.3 ± 1.6 %)). Polygonal shape and irregularity of the stone significantly reduced the probability of its self-discharge.
Turning to the criterion of the nature of stone, we found a significant difference between treatment of groups of patients with irregular surface of the stone: 5 (0.6 ± 0.3 %) patients in the spontaneous elimination of stones against 21 (11.2 ± 2.3 %) (p < 0.001) in the group with the absence of irregularity. There were no significant differences between patients with a smooth surface of the stone: 505 (62.1 ± 1. 7%) versus 113 (60.4 ± 3.6 %) (p < 0.05).


References


Боржiєвський А.Ц. Уретеролiтiаз / А.Ц. Боржієвський, С.О. Возіанов. — Л., 2007. — 264 с.

Рощин Ю.В. Консервативная терапия в лечении камней мочеточника / Ю.В. Рощин // Медико-соціальні проблеми сім’ї. — 2007. — Т. 12, № 3–4. — С. 70-74.

Retrieval methods for urinary stones / Y.M. Marickar, N. Nair, G. Varma [et al.] // Urol. Res. — 2009. — Vol. 37, № 6. — Р. 369-376.

Naja V. Tamsulosin facilitates earlier clearance of stone fragments and reduces pain after shockwave lithotripsy for renal calculi: results from an open-label randomized study /

V. Naja, M.M. Agarwal, A.K. Mandal // Urology. — 2008. — Vol. 72, № 5. — Р. 1006-1011.

Sáenz Medina J. Prognostic factors of spontaneous expulsion in ureteral lithiasis / Medina J. Sáenz, Parra R.O. Alarcón, Gonzalez E. Redondo // Actas Urol. Esp. — 2010. — Vol. 34, № 10. — Р. 882-887.

Sowter S.J. The management of ureteric colic / S.J. Sowter, D.A. Tolley // Curr. Opin. Urol. — 2006. — Vol. 16,

№ 2. — Р. 71-76.

Боржiєвський А.Ц. Уретеролiтiаз / А.Ц. Боржієвський, С.О. Возіанов. — Л., 2007. — 264 с.

Рощин Ю.В. Консервативная терапия в лечении камней мочеточника / Ю.В. Рощин // Медико-соціальні проблеми сім’ї. — 2007. — Т. 12, № 3–4. — С. 70-74.

Retrieval methods for urinary stones / Y.M. Marickar, N. Nair, G. Varma [et al.] // Urol. Res. — 2009. — Vol. 37, № 6. — Р. 369-376.

Naja V. Tamsulosin facilitates earlier clearance of stone fragments and reduces pain after shockwave lithotripsy for renal calculi: results from an open-label randomized study /

V. Naja, M.M. Agarwal, A.K. Mandal // Urology. — 2008. — Vol. 72, № 5. — Р. 1006-1011.

Sáenz Medina J. Prognostic factors of spontaneous expulsion in ureteral lithiasis / Medina J. Sáenz, Parra R.O. Alarcón, Gonzalez E. Redondo // Actas Urol. Esp. — 2010. — Vol. 34, № 10. — Р. 882-887.

Sowter S.J. The management of ureteric colic / S.J. Sowter, D.A. Tolley // Curr. Opin. Urol. — 2006. — Vol. 16,

№ 2. — Р. 71-76.




DOI: https://doi.org/10.22141/1997-2938.2.21.2013.87513

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