Analysis of factors affecting spontaneous expulsion of ureteral stones that may predict unfavorable outcomes during watchful waiting periods: What is the influence of diabetes mellitus on the ureter?
PURPOSE
The aim of our study was to evaluate the association of several factors with spontaneous stone expulsion, including ureteral stone characteristics (size, location, hydronephrosis, perinephric stranding), types of medications prescribed (α-blocker, low-dose steroid), and other possible demographic and health-history factors (gender, age, serum creatinine, underlying diabetes mellitus [DM], and hypertension).


MATERIALS AND METHODS
A total of 366 patients with ureteral stones were enrolled. All patients underwent watchful waiting without any invasive procedures. Initial diagnoses of ureteral stones were confirmed by computed tomography scans, which were taken at approximately 1-month intervals to check for stone expulsion. Univariate and multivariate analyses were conducted to identify significant factors that contributed to stone expulsion.


RESULTS
Among 366 patients, 335 patients (91.5%) experienced spontaneous stone passage during a mean follow-up period of 2.95±2.62 weeks. The patients were divided into two groups depending on the success of spontaneous stone passage. Univariate analyses revealed that stone location (p=0.003), stone size (p=0.021), and underlying DM (p<0.001) were significant predictors of stone passage. Multivariate analyses confirmed that stone size (p=0.010), stone location (p=0.008), and underlying DM (p=0.003) were independent predictive factors affecting stone passage.


CONCLUSIONS
Stone size, location, and underlying DM were confirmed to be significant predictive factors for spontaneous passage of ureteral stones. Urologists should consider active procedures, such as shock wave lithotripsy or ureteroscopy, rather than conservative management in patients presenting with proximally located stones, large ureteral stones, or underlying DM.
['Choi|Taesoo|T|', 'Yoo|Koo Han|KH|', 'Choi|Seung-Kwon|SK|', 'Kim|Dong Soo|DS|', 'Lee|Dong-Gi|DG|', 'Min|Gyeong Eun|GE|', 'Jeon|Seung Hyun|SH|', 'Lee|Hyung-Lae|HL|', 'Jeong|In-Kyung|IK|']
D000328:Adult D000368:Aged D048909:Diabetes Complications D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D011379:Prognosis D012075:Remission, Spontaneous D012189:Retrospective Studies D014057:Tomography, X-Ray Computed D016896:Treatment Outcome D014514:Ureteral Calculi D057832:Watchful Waiting
Diabetes mellitus Therapeutics Ureteral calculi Urolithiasis