Patient-reported symptoms at follow-up after a ureteral colic attack as an indication of spontaneous stone passage/remaining ureteral stone or presence of urinary tract obstruction.

Abstract

BackgroundPatient-reported symptoms is considered a possible alternative to computed tomography (CT) for the evaluation of remaining ureteral stones at follow-up after a ureteral colic attack.PurposeTo investigate patient-reported symptoms at follow-up after a ureteral colic attack in patients with a remaining ureteral stone and to assess the association of symptoms with degree of urinary obstruction.Material and MethodsThis was a prospective study of 81 patients (68 men, 13 women; mean age = 59 years; age range = 23-88 years) referred for a follow-up CT after a ureteral colic attack with a remaining unilateral ureteral stone. A dynamic enhanced scan defined urinary obstruction. Stone size was the largest diameter of three multiplanar reformatations (axial, coronal, sagittal). Stone location was registered as proximal, mid-ureter or distal. Symptoms were registered in standardized questionnaires by the patient at the time of the follow-up.ResultsIn total, 43/81 (53%) patients reported symptoms. Obstruction of any degree was present in 16 (20%) patients. In 7 (100%) patients with moderate-severe obstruction reported discomfort attributed to the stone. In patients with mild obstruction, 5 (56%) reported discomfort; in patients with no obstruction, 31 (48%) reported discomfort.ConclusionAlmost half of the patients at follow-up reported no discomfort despite having a stone in the ureter. A significant association was found between a higher degree of obstruction and reported symptoms. Asymptomatic stones and silent partial obstruction could be missed based on reported symptoms. Imaging is still required to evaluate stone passage at follow-up after a ureteral colic attack.