PREDICTIVE FACTORS AFFECTING THE SUCCESS OF MEDICAL EXPULSIVE THERAPY IN PATIENTS WITH DISTAL URETERAL STONE

Year 2024, , 443 - 447, 21.10.2024

Kaan Karamık , Hakan Anıl , Ekrem İslamoğlu

https://doi.org/10.18229/kocatepetip.1390134

Abstract

OBJECTIVE: In this study, we aimed to investigate the factors affecting spontaneous stone passing in patients who received medical expulsive therapy due to distal ureteral stones.
MATERIAL AND METHODS: From September 2022 to October 2023, a total of 148 patients with distal ureteral stones sized 4-10 mm were included. Patients received silodosin 4 mg as medical expulsive therapy and were followed up for a maximum of four weeks. The patient- and stone-related variables affecting spontaneous stone passage were evaluated.
RESULTS: The mean age of the participants was 42.92±12.78 years. The stone expulsion rate was 64.2%. The rate of spontaneous stone passage was significantly higher in patients with lower stone size, stone burden, ureteral wall thickness, distance of the stone to the ureterovesical junction, neutrophil-lymphocyte ratio and hydronephrosis grade. (all, p<0.05). The distance of the stone to the ureterovesical junction, ureteral wall thickness, and neutrophil-to-lymphocyte ratio were independent predictors of spontaneous passage (p:0.036, p:0.001, p:0.001, respectively).
CONCLUSIONS: The distance of stone to the ureterovesical junction, ureteral wall thickness, and neutrophil-to-lymphocyte ratio can be useful parameters to estimate spontaneous stone expulsion. These factors play important roles in decision-making for the management of distal ureteral stones.

Keywords

Ureteral Calculi, Urolithiasis, Medical expulsive therapy.

DİSTAL ÜRETER TAŞI OLAN HASTALARDA MEDİKAL EKSPULSİF TEDAVİNİN BAŞARISINI ETKİLEYEN ÖNGÖRÜCÜ FAKTÖRLER

Abstract

AMAÇ: Bu çalışmada distal üreter taşı nedeniyle medikal ekspulsif tedavi başlanan hastalarda spontan taş düşürmeyi etkileyen faktörleri araştırmayı amaçladık.
GEREÇ VE YÖNTEM: Eylül 2022 ve Ekim 2023 tarihleri arasında 4-10 mm boyutlarında distal üreter taşı olan toplam 148 hasta dahil edildi. Hastalara medikal ekspülsif tedavi olarak silodosin 4 mg başlandı ve en fazla dört hafta takip edildi. Spontan taş düşürmeyi etkileyen hasta ve taşa bağlı değişkenler değerlendirildi.
BULGULAR: Katılımcıların yaş ortalaması 42,92±12,78 yıldı. Taş düşürme oranı %64,2 idi. Taş boyutu, taş yükü, üreter duvar kalınlığı, taşın üreterovezikal bileşkeye olan uzaklığı, nötrofil lenfosit oranı ve hidronefroz derecesi daha düşük olan hastalarda spontan taş düşürme oranı anlamlı olarak daha yüksekti (hepsi için p<0.05). Çok değişkenli analizde, taşın üreterovezikal bileşkeye olan mesafesi, üreter duvar kalınlığı ve nötrofil-lenfosit oranı spontan pasajın bağımsız belirleyicileriydi (sırasıyla p:0.036, p:0.001, p:0.001).
SONUÇ: Taşın üreterovezikal bileşkeye olan mesafesi, üreter duvar kalınlığı ve nötrofil-lenfosit oranı, spontan taş düşürmeyi tahmin etmede yararlı parametreler olabilir. Bu faktörler distal üreter taşlarının tedavisine yönelik karar verme sürecinde önemli bir rol oynamaktadır.

Keywords

Üreter taşları, Ürolitiyaz, Medikal ekspulsif tedavi.

Ethical Statement

Ethics committee approval was received from Antalya Training and Research Hospital. (Approval number: 2023-14/8).

References

• 1. Ramello A, Vitale C, Marangella M. Epidemiology of nephrolithiasis. J Nephrol. 2000;13(3):45-50.
• 2. Pak CY. Kidney stones. Lancet. 1998;351:1797-1801.
• 3. Türk C, Petrík A, Sarica K, et al. EAU guidelines on diagnosis and conservative management of urolithiasis. Eur Urol. 2016;69:468–74.
• 4. Ordon M, Andonian S, Blew B, Schuler T, Chew B. Pace KT. CUA, guideline: management of ureteral calculi. Can Urol Assoc J. 2015;9:837–51.
• 5. Tzortzis V, Mamoulakis C, Rioja J, Gravas S, et al. Medical expulsive therapy for distal ureteral stones. Drugs. 2009;69(6):677-92.
• 6. Liu H, Wang S, Zhu W, et al. Comparative efficacy of 22 drug interventions as medical expulsive therapy for ureteral stones: a systematic review and network meta-analysis. Urolithiasis. 2020;48(5):447- 57.
• 7. Abdelaal MA, El-Dydamony EM. Comparative study between Tamsulosin, Silodosin and Tadalafil as a medical expulsive therapy for lower ureteral Stones. Arch Ital Urol Androl. 2023;95(1):10849.
• 8. Sharma G, Kaundal P, Pareek T, et al. Comparison of efficacy of various drugs used for medical expulsive therapy for distal ureter stones: A systematic review and network meta-analysis. Int J Clin Pract. 2021;75(9):14214.
• 9. Yu ZW, Wang RH, Zhang CC, Gao JG. The efficacy and safety of alpha-adrenergic blockers for medical expulsion therapy in patients with ureteral calculi: A meta-analysis of placebo-controlled trials. Medicine (Baltimore). 2021;100(37):e27272.
• 10. Sharma G, Pareek T, Kaundal P, et al. Comparison of efficacy of three commonly used alpha-blockers as medical expulsive therapy for distal ureter stones: A systematic review and network meta-analysis. Int Braz J Urol. 2022;48(5):742-59.
• 11. Yuksel M, Yilmaz S, Tokgoz H, et al. Efficacy of silodosin in the treatment of distal ureteral stones 4 to 10 mm in diameter. Int J Clin Exp Med. 2015; 8(10):19086–19092.
• 12. Cupp MA, Cariolou M, Tzoulaki I, et al. Neutrophil to lymphocyte ratio and cancer prognosis: an umbrella review of systematic reviews and meta-analyses of observational studies. BMC Med. 2020;18(1):360.
• 13. Yamaguchi K, Minei S, Yamazaki T, et al. Characterization of ureteral lesions associated with impacted stones. Int J Urol. 1999;6(6):281-5.
• 14. Heidar NA, Labban M, Bustros G, Nasr R. Inflammatory serum markers predicting spontaneous ureteral stone passage. Clin Exp Nephrol. 2020;24(3):277-83.
• 15. Lee KS, Ha JS, Koo KC. Significance of Neutrophil-to-Lymphocyte Ratio as a Novel Indicator of Spontaneous Ureter Stone Passage. Yonsei Med J. 2017;58(5):988-93.
• 16. Aghaways I, Ibrahim R, Bapir R, et al. The role of inflammatory serum markers and ureteral wall thickness on spontaneous passage of ureteral stone < 10 mm: A prospective cohort study. Ann Med Surg (Lond). 2022;80:104198.
• 17. Ramasamy V, Aarthy P, Sharma V, Singh Thakur AP. Role of inflammatory markers and their trends in predicting the outcome of medical expulsive therapy for distal ureteric calculus. Urol Ann. 2022;14:8-14.
• 18. Jain A, Sreenivasan SK, Manikandan R, et al. Association of spontaneous expulsion with C-reactive protein and other clinico-demographic factors in patients with lower ureteric stone. Urolithiasis. 2020;48(2):117-22.
• 19. Selvi I, Baydilli N, Tokmak TT, et al. CT-related parameters and Framingham score as predictors of spontaneous passage of ureteral stones ≤ 10 mm: results from a prospective, observational, multicenter study. Urolithiasis. 2021;49(3):227-37.
• 20. Kachroo N, Jain R, Maskal S et al. Can CT-Based Stone Impaction Markers Augment the Predictive Ability of Spontaneous Stone Passage? J Endourol. 2021;35(4):429-35.
• 21. Ahmed AF, Gabr AH, Emara AA, et al. Factors predicting the spontaneous passage of a ureteric calculus of 10 mm. Arab J Urol. 2015;13(2):84-90.
• 22. Samir M, Elawady H, Hamid E, Tawfick A. Can ureteral wall thickness (UWT) be used as a potential parameter for decision-making in uncomplicated distal ureteral stones 5-10 mm in size? A prospective study. World J Urol. 2021;39(9):3555-61.
• 23. Bokka S, Jain A. Hounsfield unit and its correlation with spontaneous expulsion of lower ureteric stone. Ther Adv Urol. 2019;11:1756287219887661.
• 24. Sahin MO, Sen V, Irer B, et al. Can the Hounsfield unit predict the success of medical expulsive therapy using silodosin in 4- to 10-mm distal ureteral stones? Int J Clin Pract. 2021;75(4):e13844.