Andrew C Meltzer1, Pamela Katzen Burrows2, Ziya Kirkali3, Judd E Hollander4, Michael Kurz5, Patrick Mufarrij6, Allan B Wolfson7, Cora MacPherson2, Scott Hubosky4, Nataly Montano8, Stephen V Jackman9. 1. Department of Emergency Medicine, George Washington University School of Medicine & Health Sciences, Washington, DC. Electronic address: ameltzer@mfa.gwu.edu. 2. The George Washington University Biostatistics Center, Washington, DC. 3. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD. 4. Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA. 5. Department of Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL. 6. Department of Urology, George Washington University School of Medicine & Health Sciences, Washington, DC. 7. Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. 8. Department of Emergency Medicine, George Washington University School of Medicine & Health Sciences, Washington, DC. 9. Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Abstract
OBJECTIVE: To study patients who initially presented to the Emergency Department with acute renal colic to determine if patient-reported stone passage detects stone expulsion as accurately as follow-up computed tomography (CT) scan. METHODS: This is a secondary analysis of a multi-center prospective trial of patients diagnosed by a CT scan with a symptomatic ureteral stone <9 mm in diameter. Patient-reported stone passage, defined as capture or visualization of the stone, was compared to CT scan-confirmed passage performed 29-36 days after initial presentation. RESULTS:Four-hundred-three patients were randomized in the original study and 21 were excluded from this analysis because they were lost to follow-up or receivedureteroscopic surgery. Of the 382 remaining evaluable patients, 237 (62.0%) underwent a follow-up CT scan. The mean (standard deviation) diameter of the symptomatic kidney stone was 3.8 mm (1.4). In those who reported stone passage, 93.8% (91/97) demonstrated passage of the symptomatic ureteral stone on follow-up CT. Of patients who did not report stone passage, 72.1% (101/140) demonstrated passage of their stone on follow-up CT. CONCLUSIONS: For patients who report capture or visualization of a ureteral stone, a follow-up CT scan may not be needed to verify stone passage. For patients who do not capture their stone or visualize stone passage, imaging should be considered to confirm passage.
RCT Entities:
OBJECTIVE: To study patients who initially presented to the Emergency Department with acute renal colic to determine if patient-reported stone passage detects stone expulsion as accurately as follow-up computed tomography (CT) scan. METHODS: This is a secondary analysis of a multi-center prospective trial of patients diagnosed by a CT scan with a symptomatic ureteral stone <9 mm in diameter. Patient-reported stone passage, defined as capture or visualization of the stone, was compared to CT scan-confirmed passage performed 29-36 days after initial presentation. RESULTS: Four-hundred-three patients were randomized in the original study and 21 were excluded from this analysis because they were lost to follow-up or received ureteroscopic surgery. Of the 382 remaining evaluable patients, 237 (62.0%) underwent a follow-up CT scan. The mean (standard deviation) diameter of the symptomatic kidney stone was 3.8 mm (1.4). In those who reported stone passage, 93.8% (91/97) demonstrated passage of the symptomatic ureteral stone on follow-up CT. Of patients who did not report stone passage, 72.1% (101/140) demonstrated passage of their stone on follow-up CT. CONCLUSIONS: For patients who report capture or visualization of a ureteral stone, a follow-up CT scan may not be needed to verify stone passage. For patients who do not capture their stone or visualize stone passage, imaging should be considered to confirm passage.
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Authors: Jason Y Lee; Sero Andonian; Naeem Bhojani; Jennifer Bjazevic; Ben H Chew; Shubha De; Hazem Elmansy; Andrea G Lantz-Powers; Kenneth T Pace; Trevor D Schuler; Rajiv K Singal; Peter Wang; Michael Ordon Journal: Can Urol Assoc J Date: 2021-12 Impact factor: 1.862
Authors: Andrew C Meltzer; Allan B Wolfson; Patrick Mufarrij; Cora MacPherson; Nataly Montano; Ziya Kirkali; Pamela Katzen Burrows; Stephen V Jackman Journal: J Endourol Date: 2021-01-21 Impact factor: 2.619