Predictors of surgical intervention following initial surveillance for acute ureteric colic
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To identify clinical and stone-related factors predicting the need for surgical intervention in patients who were clinically considered appropriate for non-surgical intervention.
Patients and methods
We conducted a retrospective review of a contemporary cohort of patients who were selected for surveillance following presentation with acute ureteric colic. Data on patient demographic and stone variables, inpatient management and long-term outcomes were evaluated. Multivariate logistic regression was used to generate a nomogram predicting need for surgical intervention. The accuracy of the nomogram was subsequently validated with an independent cohort of patients presenting with ureteric colic.
Of 870 study eligible patients presenting with acute ureteric colic, 527 were initially treated non-surgically and included in the analysis. 113 of these eventually required surgical intervention. Median time from first presentation to acute surgery was 11 (IQR 4–82) days. In our final MVA analysis, duration of symptoms more than 3 days, not receiving alpha-blockers, positive history of previous renal calculi and stone location, burden and density were independent predictors of need for surgical intervention. Patients who required opioid analgesia were more likely to have surgical intervention; however, this did not reach statistical significance. The area under the curve (AUC) of the final model was 0.802. The nomogram was validated with a cohort of 210 consecutive colic patients with AUC of 0.833 (SE 0.041, p < 0.001).
We have identified independent predictors of the need for surgical intervention during an episode of renal colic and formulated a nomogram. Combined with the diligent use of acute ureteroscopy at our centre, this nomogram may have clinical utility when making decisions regarding treatment options with potential healthcare cost savings.
KeywordsUreteroscopy Renal colic Nephrolithiasis Nomograms
Mohit Bajaj: Manuscript writing, Lance Yuan: Data collection, Lauren C. Holmes: Data collection, Michael Rice: Protocol/project development, Kamran Zargar-Shoshtari: Protocol/project development, Analysis, Manuscript writing/editing.
This study was partly funded from Counties Manukau Health Summer Studentship to Miss Lauren C Holmes.
Compliance with ethical standards
Conflict of interest
No other sources of funding or conflicts of interest to disclose.
This is a retrospective study and a formal consent is not required. Institutional ethical approval was obtained for this retrospective study.
Research involving human participants and/or animals
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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