Characterizing patients with multiple same-sided ureteric stones

Abstract

Purpose

Patients presenting with multiple same-sided ureteric stones (MSSUS) are a unique population with nuanced prognostic and treatment considerations, which have yet to be characterized in the literature. Therefore, our purpose was to examine outcomes of patients with MSSUS vs those with single ureteric stones (SUS).

Methods

A retrospective review of prospectively collected patients included adults (> 18yo) with $\ge$ 2 ipsilateral ureteral stones without prior treatment for their current stone burden. A historical comparison group was used as a control population. Univariate logistic regression analyses and descriptive statistics were performed with SPSS^® 20.0 (p < 0.05).

Results

Seventy-nine MSSUS patients were compared to 101 SUS patients. MSSUS patients had 2.21 $\pm$ 0.66 ureteric stones and had significantly smaller lead stones (MSSUS 6.4 mm vs SUS 7.2 mm, p = 0.03). MSSUS patients were more likely to have had prior stones (66 vs 42%) and 5.9 times more likely to have had prior stone procedures. Conservative management was successful in 30% MSSUS vs 19% SUS (p = 0.073), and there were no differences in resolution time (p = 0.44). For patients proceeding to intervention, (MSSUS n = 52, SUS n = 78), ureteroscopy was performed on 58% MSSUS vs 51% SUS patients (p = 0.302), and shockwave lithotripsy in 10% MSSUS vs 26% SUS (p = 0.01). MSSUS were more likely to spontaneously pass a stone prior to planned intervention (OR = 41.1; 95% CI = 12.0–140.7; p = 0.0001).

Conclusion

MSSUS patients are more likely recurrent stone formers with extensive stone histories and current stone burdens. Conservative management appears as successful between groups, with no difference in resolution time. When employed, ureteroscopy outcomes do not different between cohorts.