Gender differences in acute stone admissions - should we have a lower threshold for treatment in female patients?

OBJECTIVES: To examine the gender-related differences in the presentation, management and outcomes of patients admitted with acute renal colic at our institution. PATIENTS AND METHODS: A retrospective analysis of 231 consecutive patients requiring inpatient admission for acute renal colic between October 2015 and March 2018. For each admission, data on demographics, admission blood results, stone characteristics, management and outcomes were collected. Differences between genders were compared using the chi-squared and Student's t-test. RESULTS: Gender distribution was 35% female: 65% male. There was no significant difference in age, American Society of Anesthesiologists Physical Status Classification grade or history of diabetes. Women had a higher admission C-reactive protein level (89.3 vs 32.9 mg/L, P < 0.001) and neutrophil count (10.0 vs 8.8 × 109 /L, P = 0.04) than men. They also had more positive cultures (34.1% vs 6.0%, P < 0.001) and were more likely to require percutaneous nephrostomy insertion (9.8% vs 0.7%, P = 0.005). Women had more intensive therapy unit (ITU) admissions (12.2% vs 0.6%, P < 0.001) and longer lengths of stay (4.4 vs 1.8 days, P < 0.001) than men. There was no mortality in our series. CONCLUSION: In the present study, women admitted with acute renal colic were more likely to have an associated infection than men and require rapid decompression. Although there was no difference in mortality, women experienced greater morbidity as evidenced by the higher rate of ITU admissions and longer length of stay. These differences are important to consider when assessing the suitability of conservative management for female patients.

Predicting emergency interventions in patients with acute ureteral colic using acute renal colic scoring system in a Pakistani cohort.

OBJECTIVE: To evaluate the acute renal colic score (ARC) in predicting the need of emergency intervention (EI) in patients with ureteric colic secondary to a ureteral stone. PATIENT AND METHODS: In an emergency room (ER) of a university hospital, we conducted a prospective cohort study over a period of 6 months. ARC score was calculated using four parameters, i.e., serum creatinine, total white cell count (TLC), stone length and level. Primary outcome measure was EI, which was defined as the need of endourological intervention within 48 h of presentation. ARC was calculated for each patient against the two possible outcomes, i.e., EI vs. no EI. The need of intervention was based on patient-related clinical factors and the decision of the attending urologist. RESULTS: The study included 132 patients. EI was performed in 85 patients (64.4%). URS was the most common intervention performed in 81 (95.3%) patients, followed by the a insertion of a double J stent in two (2.4%) patients for forniceal rupture and high TLC count and percutaneous nephrostomy in two (2.4%) patients for raised creatinine and TLC. All four variables in ARC score including serum creatinine (p < 0.001), TLC (p < 0.001), stone size (p < 0.001) and stone level (p < 0.001) were found to be significantly associated with need for EI. Using ROC the sensitivity and specificity of the score was 92.9% and 87.5%, respectively, with AUC of 0.93. CONCLUSIONS: ARC score is highly sensitive and specific in determining the need of EI in patients with uncomplicated ureteric colic within 48 h of initial presentation.

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

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.

Laboratory markers has many valuable parameters in the discrimination between acute appendicitis and renal colic.

BACKGROUND: Only one diagnostic parameter is not available for acute appendicitis. For the establishment of diagnosis, combination of medical history, clinical, laboratory tests, and radiological imaging modalities are used so as to decrease the rates of negative laparotomy and morbidity secondary to delay in diagnosis. Thepresent study aimed to determine haematological and inflammatory markers which will be used in the discrimination of acute appendicitis (AA) and renal colic which are the most frequent and indistinguishable causes of abdominal pain in patients applying to the emergency service. METHODS: A total of 215 patients who presented with abdominal pain and who were histopathologically diagnosed as AA, and 200 patients who presented with abdominal pain and who were diagnosed as renal colic were included into the study. Control group consisted of 61 patients without any complaints who came to the outpatient clinics of internal medicine only for blood counts. Analyzed blood samples were WBC, RDW, Hb, MCV, MPV, neutrophil, lymphocyte, NLR and PLR. All differences associated with a chance probability of.05 or less were considered statistically significant. RESULTS: A statistically significant intergroup difference was seen between AA and renal colic groups as for age, WBC, Hb, MCV, neutrophil, lymphocyte, NLR and PLR. A statistically significant intergroup difference was seen between AA and control groups regarding age, WBC, Hb, RDW, MPV, neutrophil, lymphocyte, NLR and PLR. A statistically significant intergroup difference was seen between renal colic and control groups as for age, WBC, RDW, MPV, neutrophil and NLR. In ROC curve analysis, the area under AUCs for WBC, neutrophil, NLR and PLR were 0.896, 0.916, 0.888 and 0.725, respectively (p≤0.05). CONCLUSION: In the discrimination between patients with renal colic and those without any illness, WBC, RDW, MPV, neutrophil and NLR; in the differentiation between the patients with AA and healthy individuals, WBC, RDW, MPV, neutrophil, lymphocyte, NLR and PLR; and more importantly in the discrimination between patients with AA and those with renal colic who presented to emergency services with abdominal pain WBC, neutrophil, lymphocyte, PLR and NLR can be useful parameters.

A novel model to predict the risk of readmission in patients with renal colic.

UNLABELLED: Abstract Purpose: To identify the clinical, laboratory, and imaging parameters that may increase the risk of readmission in patients with renal colic that is managed by active surveillance and to produce a novel model to predict the risk for this. PATIENTS AND METHODS: We retrospectively reviewed patients with renal colic secondary to ureteral calculi admitted to our hospital from March 2009 until September 2010. The colic was managed with active surveillance for 6 weeks. Patients were divided into those who were not readmitted to the hospital within the follow-up period (group A) and those who were (group B). RESULTS: From the 452 studied patients, 82 (18.1%) were readmitted to the hospital. Stone size (P<0.001) and location (P<0.001) and serum white blood cell count (P=0.009) were statistically significantly different between groups. These parameters were found to be independent predictors for readmission. A predictive model was produced to calculate the risk of readmission. CONCLUSIONS: Stone size and location and white blood cell count are independent predictors for potential readmission in patients with renal colic. Using these parameters, we may calculate the risk for readmission, and the latter may assist physicians in identifying the best treatment option.

[Influence of "Sancai" acupuncture treatment on plasma and urine SP, 5-HT levels of renal colic patients].

OBJECTIVE: To observe the effect of "Sancai Needling" (superficial, medium and deep insertion of the acupuncture needle) combined with electroacupuncture ( EA) stimulation of Shenshu ( BL 23) on plasma and urine SP and 5- HT levels in renal colic patients, so as to study its mechanism underlying improvement of renal colic. METHODS: Sixty renal colic patients (lower-energizer stasis type) were randomly allocated to "Sancai Needling" -EA group, Ashi-point-EA group and routine EA treatment group, with 20 cases in each group. The "Sancai Needling"-EA meant that an acupuncture needle was inserted into the subcutaneous layer of BL 23 first and EA stimulation was given for 10 min; then the needle was inserted into the medium layer (muscle layer) and EA stimulation performed for 10 min; at last, the needle was further inserted into the periosteum-muscle layer and EA was performed for 10 min again. The procedures for Ashi-point-EA group were the same. For patients of the routine EA treatment group, EA was applied to BL 23 for 30 min. The therapeutic effect for pain was assessed according to McGill Pain Questionnaire. Plasma and urine SP and 5-HT contents were determined using enzyme-labeled immunosorbent assay (ELISA) . RESULTS: In comparison with pre-treatment, pain scores, plasma and urine SP and 5-HT contents were remarkably decreased in renal colic patients of the "Sancai Needling"-EA group, Ashi-point-EA group and routine EA treatment group after the treatment ( P<0. 05). The effects of the "Sancai Needling"-EA group and Ashi-point-EA group were significantly superior to those of the routine EA treatment group in reducing pain score, plasma and urine SP and 5-HT contents( P<0. 05). No statistical differences were found between the "Sancai Needling"-EA group and Ashi-point-EA group in pain score, plasma and urine SP and 5-HT contents ( P>0. 05). CONCLUSION: "Sancai Needling"-EA treatment is effective in relieving renal colic in the patients, which may be closely associated with its effects in down-regulating plasma SP and 5-HT levels.

Pain levels associated with renal colic and primary dysmenorrhea: a prospective controlled study with objective and subjective outcomes.

OBJECTIVES: To evaluate the degree of pain associated with renal colic and primary dysmenorrhea using objective and subjective measurements. METHODS: In total, 60 subjects participated in this study. There were 20 subjects in the renal colic group (average age 24.45 ± 2.35 years), 20 subjects in the primary dysmenorrhea group (average age 23.75 ± 1.86 years), and 20 subjects in the control group (average age 24.20 ± 2.57 years). The serum chromogranin A (CgA) values were determined by an enzyme-linked immunosorbent assay and the mean pain score was assessed by means of a Visual Analog Scale (VAS) for each individual. RESULTS: The serum CgA level was 19.83 ± 19.61 ng/ml for the renal colic group, 13.45 ± 8.52 ng/ml for the primary dysmenorrhea group and 12.45 ± 7.76 ng/ml for the control group. The mean VAS score for pain was 7.95 ± 1.54 for the renal colic group and 7.05 ± 1.50 for the primary dysmenorrhea group. CONCLUSIONS: Primary dysmenorrheic pain is as intense as renal colic pain. Emergency room physicians should display the same degree of care and attention for the treatment of patients with primary dysmenorrhea as they do for patients with renal colic, and rapidly initiate an effective treatment for these patients.

Role of white blood cell and neutrophil counts in predicting spontaneous stone passage in patients with renal colic.

OBJECTIVE: To determine the clinical, imaging and laboratory variables that can predict spontaneous passage of ureteral stones causing renal colic and the role of white blood cell (WBC) and neutrophil counts for the prediction of spontaneous calculi passage. PATIENTS AND METHODS: A total of 156 patients who were referred to the emergency department complaining of renal colic due to a ureteral stone entered the analysis. Several clinical, laboratory and imaging parameters were evaluated for their potential ability to predict stone passage in a time interval of 1 month. The study design had two objectives. Primarily we analyzed all patients irrespective of stone size and secondly we analyzed patients with calculi of 10 mm maximum length. RESULTS: Spontaneous stone passage was observed in 96 (61.5%) patients in the overall population and in 84 (65.1%) of 129 patients with calculi <10 mm. Increased concentrations of serum WBCs and neutrophils at the time of the acute phase of a renal colic were associated with increased likelihood of spontaneous passage. In the multivariate analyses we found that WBC and neutrophil counts were the most important predictors of stone elimination. CONCLUSIONS: Active surveillance of patients suffering from ureteral lithiasis is an acceptable option. Identifying the parameters which can predict those patients who will mostly benefit from this is of great importance. Based on our results, WBC and neutrophil counts should be considered when patients with renal colic secondary to ureteral calculi are evaluated since they can significantly add to spontaneous elimination prediction. Their consideration in addition to other important factors, like stone size and location, would maximize their predictive ability.