Is computed tomography-defined obstruction a predictor of urological intervention in emergency department patients presenting with renal colic?

Authors

  • Peter Alexander Massaro Department of Urology, Dalhousie University, Halifax, NS, Canada
  • Avinash Kanji Faculty of Medicine, University College Cork National University of Ireland, Cork, Ireland Department of Emergency Medicine, Horizon Health Network, Saint John, NB, Canada
  • Paul Atkinson Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
  • Ryan Pawsey Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
  • Tom Whelan Department or Urology, Dalhousie University, Halifax, NS, Canada

DOI:

https://doi.org/10.5489/cuaj.4143

Abstract

Introduction: Our objective was to determine whether unilateral calculus-induced ureteric obstruction on computed tomography (CT) was independently associated with the need for urological intervention and 30-day return to the emergency department (ED).

Methods: We performed a retrospective cohort study of patients with symptomatic urinary calculi diagnosed by unenhanced helical CT. Stepwise regression analysis was used to determine the predictors of urological intervention and 30-day return to the ED. Potential predictors assessed included: patient demographics, calculus size, calculus location, degree of obstruction, analgesic doses, signs and symptoms of infection, serum creatinine, cumulative intravenous fluid administered, and the prescription of medical expulsive therapy.

Results: Of 195 patients, 81 (41.5%) underwent urological intervention. The size of the calculus, its location, and the cumulative opioid dose were all independent predictors for urological intervention. Every 1 mm increase in calculus size increased the likelihood of intervention 2.2 times (odds ratio [OR] 2.17; 95% confidence interval [CI] 1.67‒2.85). Proximal stones were 4.7 times more likely to require intervention than distal calculi (OR 0.21; 95% CI 0.09‒0.49). Every 10 mg increase in morphine was associated with a 30% increase in the odds of intervention (OR 1.30; 95% CI 1.07‒1.58). Degree of obstruction was not associated with the need for urological intervention. Finally, none of the variables were predictors for 30-day return to the ED.

Conclusions: Although stone size, proximal location, and severe pain, as indicated by higher opioid doses, were associated with the need for intervention, the degree of obstruction did not influence the management of patients with CT-defined urinary calculi.

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Author Biographies

Peter Alexander Massaro, Department of Urology, Dalhousie University, Halifax, NS, Canada

MD, MASc, FRCSC

Avinash Kanji, Faculty of Medicine, University College Cork National University of Ireland, Cork, Ireland Department of Emergency Medicine, Horizon Health Network, Saint John, NB, Canada

Medical Student

Paul Atkinson, Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada

MD, FRCPC

Ryan Pawsey, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada

MD

Tom Whelan, Department or Urology, Dalhousie University, Halifax, NS, Canada

MD, FRCSC

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Published

2017-04-11

How to Cite

Massaro, P. A., Kanji, A., Atkinson, P., Pawsey, R., & Whelan, T. (2017). Is computed tomography-defined obstruction a predictor of urological intervention in emergency department patients presenting with renal colic?. Canadian Urological Association Journal, 11(3-4), 88–92. https://doi.org/10.5489/cuaj.4143

Issue

Section

Original Research