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Association of spontaneous expulsion with C-reactive protein and other clinico-demographic factors in patients with lower ureteric stone

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Abstract

The purpose of our study is to analyze the definitive relation of C-reactive protein (CRP) and other factors with the spontaneous stone passage in patients with distal ureteric calculus of 5–10 mm and to calculate the risk of failure of expectant management in patients. 185 patients of ureteric colic, who were subjected to medical expulsive therapy (MET), were included prospectively from August 2016 to May 2018 and followed up for 4 weeks. Patients were divided into two groups. Group A included successful spontaneous passage patients and group B included failure in the same. The parameters analyzed were age, gender, longitudinal and transverse diameter of stone, CRP, total leucocyte count, ureteric diameter and hydroureteronephrosis (HUN). We performed univariate and multivariate analysis. Receiver operating characteristics curve was used to determine the cutoff value for significantly associated variables. 122 (65.90%) and 63 (34.10%) patients were included in group A and B, respectively. In univariate analysis, CRP, longitudinal and transverse diameter of stone, HUN, proximal and distal ureteric diameters were statistically significant. However, in multivariate analysis, only negative CRP (p = 0.002), smaller longitudinal diameter of stone (p < 0.001) and absence of HUN (p = 0.005) were significantly associated with successful expulsion. Cutoff for CRP was 0.41 mg/dl and longitudinal diameter was 6.7 mm. The success rate in the group of patients with no risk factor was 96.7% and with all three risk factors was 16.7%. Patients with a longitudinal diameter of stone > 6.7 mm, HUN, and CRP > 0.41 mg/dl should be considered for early intervention. The success rate of MET can be increased to 86% after exclusion of patients with all three risk factors.

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References

  1. Rukin N, Siddiqui Z, Chedgy E, Somani B (2016) Trends in upper tract stone disease in England: evidence from the hospital episodes statistics database. Urologia Internationalis 98(4):391–396

    Article  Google Scholar 

  2. Elton T, Roth C, Berquist T, Silverstein D (1993) A clinical prediction rule for the diagnosis of ureteral calculi in emergency departments. J Gen Intern Med 8(2):57–62

    Article  CAS  Google Scholar 

  3. Dellabella M, Milanese G, Muzzonigro G (2003) Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol 170(6):2202–2205

    Article  CAS  Google Scholar 

  4. Wang H, Man L, Huang G, Li G, Wang J (2016) Comparative efficacy of tamsulosin versus nifedipine for distal ureteral calculi: a meta-analysis. Drug Des Dev Ther 10:1257–1265

    Article  CAS  Google Scholar 

  5. Sfoungaristos S, Kavouras A, Perimenis P (2011) Predictors for spontaneous stone passage in patients with renal colic secondary to ureteral calculi. Int Urol Nephrol 44(1):71–79

    Article  Google Scholar 

  6. Celik S, Akdeniz F, Yildirim M, Bozkurt O, Bulut M, Hacihasanoglu M et al (2017) Computed tomography findings predicting the success of silodosin for medical expulsive therapy of ureteral stones. Kaohsiung J Med Sci 33(6):290–294

    Article  Google Scholar 

  7. Ahmed A, Al-Sayed A (2010) Tamsulosin versus alfuzosin in the treatment of patients with distal ureteral stones: prospective, randomized, comparative study. Korean J Urol 51(3):193

    Article  Google Scholar 

  8. Furyk J, Chu K, Banks C, Greenslade J, Keijzers G, Thom O et al (2016) Distal ureteric stones and tamsulosin: a double-blind, placebo-controlled, randomized multicenter trial. Ann Emerg Med 67(1):86–95.e2

    Article  Google Scholar 

  9. Hollingsworth J, Canales B, Rogers M, Sukumar S, Yan P, Kuntz G et al (2016) Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. BMJ 355:i6112

    Article  Google Scholar 

  10. Wang C, Huang S, Chang C (2008) Efficacy of an α1 blocker in expulsive therapy of lower ureteral stones. J Endourol 22(1):41–46

    Article  Google Scholar 

  11. Savić S, Vukotić V, Lazić M, Savić N (2014) Management of calculus anuria using ureteroscopic lithotripsy as a first line treatment: its efficacy and safety. Urol J 11(2):1392–1399

    PubMed  Google Scholar 

  12. Pepys M, Hirschfield G (2003) C-reactive protein: a critical update. J Clin Investig 111(12):1805–1812

    Article  CAS  Google Scholar 

  13. Özcan C, Aydoğdu O, Senocak C, Damar E, Eraslan A, Oztuna D et al (2015) Predictive factors for spontaneous stone passage and the potential role of serum C-reactive protein in patients with 4 to 10 mm distal ureteral stones: a prospective clinical study. J Urol 194(4):1009–1013

    Article  Google Scholar 

  14. Sfoungaristos S, Kavouras A, Katafigiotis I, Perimenis P (2012) Role of white blood cell and neutrophil counts in predicting spontaneous stone passage in patients with renal colic. BJU Int 110(8b):E339–E345

    Article  Google Scholar 

  15. Park C, Ha J, Park C, Kim C, Kim K, Kim B (2013) Relationship between spontaneous passage rates of ureteral stones less than 8 mm and serum C-reactive protein levels and neutrophil percentages. Korean J Urol 54(9):615

    Article  Google Scholar 

  16. Lee K, Ha J, Koo K (2017) Significance of neutrophil-to-lymphocyte ratio as a novel indicator of spontaneous ureter stone passage. Yonsei Med J 58(5):988

    Article  Google Scholar 

  17. Miller O, Kane C (1999) time to stone passage for observed ureteral calculi: a guide for patient education. J Urol 162(3):688–691

    Article  CAS  Google Scholar 

  18. Paajanen H, Tainio H, Laato M (1996) A chance of misdiagnosis between acute appendicitis and renal colic. Scand J Urol Nephrol 30(5):363–366

    Article  CAS  Google Scholar 

  19. Sandberg T, Lidin-Janson G, Edén C (1989) Host response in women with symptomatic urinary tract infection. Scand J Infect Dis 21(1):67–73

    Article  CAS  Google Scholar 

  20. Shaoul R, Lahad A, Tamir A et al (2008) C-reactive protein (CRP) as a predictor for true bacteremia in children. Med Sci Monit 14:CR255–CR261

    CAS  PubMed  Google Scholar 

  21. Horcajada J, Velasco M, Filella X, Alvarez L, De Lazzari E, Marin J et al (2004) Evaluation of inflammatory and renal-injury markers in women treated with antibiotics for acute pyelonephritis caused by Escherichia coli. Clin Vaccine Immunol 11(1):142–146

    Article  CAS  Google Scholar 

  22. Aldaqadossi H (2013) Stone expulsion rate of small distal ureteric calculi could be predicted with plasma C-reactive protein. Urolithiasis 41(3):235–239

    Article  CAS  Google Scholar 

  23. Hada A, Yadav SS, Tomar V, Priyadarshi S, Agarwal N, Gulani A (2018) Assessment of factors affecting the spontaneous passage of lower ureteric calculus on the basis of lower ureteric calculus diameter, density, and plasma C-reactive protein level. Urol Ann 10:302–307

    Article  Google Scholar 

  24. Angulo J, Gaspar M, Rodríguez N, García-Tello A, Torres G, Núñez C (2010) The value of C-reactive protein determination in patients with renal colic to decide urgent urinary diversion. Urology 76(2):301–306

    Article  Google Scholar 

  25. McSorley S, Drury M, Majumdar P, Halsall A, Nalagatla S (2013) C-reactive protein to predict the need for surgical intervention in acute renal colic. J Clin Urol 7(6):380–383

    Article  Google Scholar 

  26. Lee S, Jeon H, Park D, Choi Y (2012) Longitudinal stone diameter on coronal reconstruction of computed tomography as a predictor of ureteral stone expulsion in medical expulsive therapy. Urology 80(4):784–789

    Article  Google Scholar 

  27. Hwang E, Kim Y, Yuk S, Sul C, Lim J (2010) Factors that predict spontaneous passage of a small distal ureteral stone %3c 5 mm. J Endourol 24(10):1681–1685

    Article  Google Scholar 

  28. Hiller N, Berkovitz N, Lubashevsky N, Salaima S, Simanovsky N (2012) The relationship between ureteral stone characteristics and secondary signs in renal colic. Clin Imaging 36(6):768–772

    Article  Google Scholar 

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Funding

This study was not funded by any agency.

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Authors and Affiliations

  1. Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Pondicherry, Puducherry, 605006, India

    Amit Jain, Sreerag Kodakkattil Sreenivasan, Ramanitharan Manikandan & Lalgudi Narayanan Dorairajan

  2. Department of Microbiology, JIPMER Pondicherry, Puducherry, 605006, India

    Sujatha Sistla

  3. Department of Radiodiagnosis, JIPMER Pondicherry, Puducherry, 605006, India

    Subathra Adithan

Authors
  1. Amit Jain
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  2. Sreerag Kodakkattil Sreenivasan
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  3. Ramanitharan Manikandan
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  4. Lalgudi Narayanan Dorairajan
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  5. Sujatha Sistla
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  6. Subathra Adithan
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Corresponding author

Correspondence to Sreerag Kodakkattil Sreenivasan.

Ethics declarations

This study is highly compliant without variation from Ethical Standard. Annual progression reports are submitted to the institutional ethical committee.

Conflict of interest

None of the authors have any conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and also the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval was obtained for the study on 05/07/2016 (JIP/IEC/2016/27/884).

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Informed consent was obtained from all individual participants included in the study.

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Jain, A., Sreenivasan, S.K., Manikandan, R. et al. Association of spontaneous expulsion with C-reactive protein and other clinico-demographic factors in patients with lower ureteric stone. Urolithiasis 48, 117–122 (2020). https://doi.org/10.1007/s00240-019-01137-x

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  • DOI: https://doi.org/10.1007/s00240-019-01137-x

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