Farhan Jarral et al., 2024: Follow-Up Survey for Conservatively Managed Ureteric Stones
Farhan Jarral 1, Abdelrahman Hamdy 2, Jakub Wrazen 1, Guleed Mohamed 3, Osama Abusanad 4
1Urology, Doncaster Royal Infirmary, Doncaster, GBR.
2General Surgery, Doncaster Royal Infirmary, Doncaster, GBR.
3Urology, Mid-Yorkshire NHS Trust, Leeds, GBR.
4Urology, Chesterfield Royal Hospital, Chesterfield, GBR.
Abstract
Introduction Currently, there are no agreed-upon investigations and follow-up guidelines for the conservative management of ureteric stones. This study used common themes identified in previous works to investigate whether there is a consensus amongst urology consultants in the United Kingdom. Methods This was a questionnaire-based survey study. An online questionnaire was disseminated nationally to urological consultants practicing in the United Kingdom to explore a range of common factors. The initial sample size was 81 UK-based urological consultants with an interest in endourology and stone surgery. Of the initial 81, 20 participants did not complete the survey and therefore the final sample size was 61. Descriptive analysis was used to analyze the data. Results Our survey found that the main factors influencing the follow-up of conservatively managed ureteric stones were stone size 98% (60), stone location 92% (56), and the degree of altered renal function 79% (48). Regardless of stone size, most participants chose to follow up at 2-4 weeks with asymptomatic patients requiring imaging with discrepancies about the modality. Regarding biochemical markers, most participants only repeated renal function tests if this was deranged on presentation. Calcium and uric acid levels were checked regularly. Diclofenac was the analgesia of choice 93% (55). Regarding the availability of acute ESWL services, over half (59%) were able to offer acute ESWL within the week. The majority offer services at least three or more lists per week. Conclusion Our results demonstrate that there is still no overarching consensus in the follow-up of conservatively managed ureteric stones. Several factors backed by high-level evidence are already consistent across the population of urology consultants and considered "best practice." However, before any all-encompassing national guidelines are formalized, further studies in the form of randomized control trials will be needed to yield high-level evidence.
Cureus. 2024 Aug 14;16(8):e66845. doi: 10.7759/cureus.66845. eCollection 2024 Aug.
PMID: 39280434 PMCID: PMC11398841
Comments 1
One question that has been discussed during the decades is how ureteral stones best should be managed. To illustrate the current attitudes, this article summarizes the results of a questionnaire sent to 81 consultants in UK, of whom 61 responded.
The reader easily can get information of the outcome in the clear tables shown in the report.
It is of note that most patients irrespective of stone size and symptoms had follow-up after 2-4 weeks. Renal function was not recorded routinely.
Although the access to SWL varied considerably, there are no indications in the review that the responding urologists were more aggressive with endourological procedures.
Interestingly, diclofenac was the most common analgesic for patients with ureteric colic. This is a routine that clearly has changed during the past decades.
Hans-Göran Tiselius