Volume 124, Issue 3 p. 504-513
Upper Urinary Tract

Factors associated with spontaneous stone passage in a contemporary cohort of patients presenting with acute ureteric colic: results from the Multi-centre cohort study evaluating the role of Inflammatory Markers In patients presenting with acute ureteric Colic (MIMIC) study

Taimur T. Shah

Corresponding Author

Taimur T. Shah

British Urology Researchers in Surgical Training (BURST), London, UK

Division of Surgery and Cancer, Imperial College London, London, UK

Division of Surgery and Interventional Science, University College London, London, UK

Charing Cross Hospital, Imperial Health NHS Trust, London, UK

Correspondence: Taimur T. Shah, British Urology Researchers in Surgical Training (BURST), London, UK.

e-mail: [email protected]

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Chuanyu Gao

Chuanyu Gao

British Urology Researchers in Surgical Training (BURST), London, UK

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Max Peters

Max Peters

Department of Radiation Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands

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Todd Manning

Todd Manning

Australian Young Urology Researchers Organisation (YURO), Heidelberg, Victoria, Australia

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Sophia Cashman

Sophia Cashman

British Urology Researchers in Surgical Training (BURST), London, UK

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Arjun Nambiar

Arjun Nambiar

British Urology Researchers in Surgical Training (BURST), London, UK

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Marcus Cumberbatch

Marcus Cumberbatch

British Urology Researchers in Surgical Training (BURST), London, UK

Academic Urology Unit, University of Sheffield, Sheffield, UK

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Ben Lamb

Ben Lamb

British Urology Researchers in Surgical Training (BURST), London, UK

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Anthony Peacock

Anthony Peacock

Information Services Division, University College London (UCL), London, UK

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Marieke J. Van Son

Marieke J. Van Son

Department of Radiation Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands

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Peter S. N. van Rossum

Peter S. N. van Rossum

Department of Radiation Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands

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Robert Pickard

Robert Pickard

Department of Urology, Newcastle University, Newcastle

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Paul Erotocritou

Paul Erotocritou

Department of Urology, Whittington Hospital, London, UK

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Daron Smith

Daron Smith

Department of Urology, UCL Hospital, London, UK

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Veeru Kasivisvanathan

Veeru Kasivisvanathan

British Urology Researchers in Surgical Training (BURST), London, UK

Division of Surgery and Interventional Science, University College London, London, UK

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British Urology Researchers in Surgical Training (BURST) Collaborative MIMIC Study Group

British Urology Researchers in Surgical Training (BURST) Collaborative MIMIC Study Group

PubMed Indexed Collaborators (BURST Collaborative MIMIC Study Group) are presented in Appendix  1.Search for more papers by this author
First published: 18 April 2019
Citations: 27
[Correction added on 18 July 2019, after first online publication: Some author names have been updated in this version.]

Abstract

Objectives

To assess the relationship of white blood cell count (WBC) and other routinely collected inflammatory and clinical markers including stone size, stone position, and medical expulsive therapy use (MET), with spontaneous stone passage (SSP) in a large contemporary cohort of patients with acute ureteric colic, as there are conflicting data on the role of WBC and other inflammatory markers in SSP in patients with acute ureteric colic.

Patients and methods

Multicentre retrospective cohort study coordinated by the British Urology Researchers in Surgical Training (BURST) Research Collaborative at 71 secondary care hospitals across four countries (UK, Republic of Ireland, Australia, and New Zealand). In all, 4170 patients presented with acute ureteric colic and a computed tomography confirmed single ureteric stone. Our primary outcome measure was SSP, as defined by the absence of need for intervention to assist stone passage (SP). Multivariable mixed effects logistic regression was used to explore the relationship between key patient factors and SSP.

Results

In all, 2518 patients were discharged with conservative management and had further follow-up with a SSP rate of 74% (n = 1874/2518). Sepsis after discharge with conservative management was reported in 0.6% (n = 16/2518). On multivariable analysis neither WBC, neutrophils count, nor C-reactive protein (CRP) predicted SSP, with an adjusted odds ratio (OR) of 0.97 (95% confidence interval [CI] 0.91–1.04, P = 0.38), 1.06 (95% CI 0.99–1.13, P = 0.1) and 1.00 (95% CI 0.99–1.00, P = 0.17), respectively. MET also did not predict SSP (adjusted OR 1.11, 95% CI 0.76–1.61). However, stone size and stone position were significant predictors. SSP for stones <5 mm was 89% (95% CI 87–90) compared to 49% (95% CI 44–53) for stones ≥5–7 mm, and 29% (95% CI 23–36) for stones >7 mm. For stones in the upper ureter the SSP rate was 52% (95% CI 48–56), middle ureter was 70% (95% CI 64–76), and lower ureter was 83% (95% CI 81–85).

Conclusion

In contrast to the previously published literature, we found that in patients with acute ureteric colic who are discharged with initial conservative management neither WBC, neutrophil count, nor CRP, helps determine the likelihood of SSP. We also found no overall benefit from the use of MET. Stone size and position are important predictors and our present findings represent the most comprehensive SP rates for each millimetre increase in stone size from a large contemporary cohort adjusting for key potential confounders. We anticipate that these data will aid clinicians managing patients with acute ureteric colic and help guide management decisions and the need for intervention.

Conflicts of interest

Taimur T. Shah would like to acknowledge funding from the Prostate Cancer UK and St Peters Trust for clinical research and has received funding in the past for conference attendance from Astellis, Ferring and Galil Medical. Veeru Kasivisvanathan is funded by a Doctoral Research Fellowship from the National Institute for Health Research. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. Veeru Kasivisvanathan has previously received research funding from the EAU and the AUA. All other authors declare no conflicts of interest.