The aim of this study is to compare the maximum stone diameter of ureteral stones in the coronal plane to the axial and determine the clinical significance of the coronal diameter.
A retrospective chart review was performed on patients seen in clinic between September 2013 and November 2015. Patients were included if they had a history of ureteral stone noted on CT performed with coronal reconstructions. Patients were excluded if they had multiple ureteral stones, history of upper urinary tract abnormalities, need for urgent intervention, or no follow-up. Management of the ureteral stone and pertinent medical history related to their stone disease including stone diameter on axial and coronal computerized tomography (CT) imaging was captured. Multivariate regression was performed to identify predictive factors for stone passage.
150 patients met inclusion criteria.54 spontaneously passed stones and 96 required surgery.The reading radiologist reported the stone measurement in the coronal dimension in 17% of cases.In 75% of cases the coronal diameter was larger than the axial diameter by an average of 1.2 mm.On univariate analysis, stone passage was associated with axial diameter (p<0.001), coronal diameter (p<0.001), stone location (p=0.001), age (p<0.001), and medical expulsion therapy (p =0.008). On multivariate analysis, only coronal diameter (p<0.001), stone location (p=0.01), and age (p=0.03) remained significant factors associated with spontaneous passage.
In the current series, only stone size as measured in the coronal diameter was associated with stone passage versus need for surgical intervention on multivariate analysis.We strongly recommend obtaining coronal reconstructions when CT is performed for ureteral stone to guide management decisions and appropriately counsel patients on the probability of stone passage.
Urology. 2017 Jan 12 [Epub ahead of print]
Mustafa Kadihasanoglu, Tracy Marien, Nicole L Miller
Vanderbilt University Medical Center, Nashville, TN. Electronic address: ., Vanderbilt University Medical Center, Nashville, TN.