Natural history of conservatively managed ureteric stones from a cumulative analysis of 6600 patients

Introduction Ureteric colic has a lifetime prevalence of 10% to 15% and is one of the most common emergency urological presentations. Current EAU recommends conservative management for 'small' (&lt;6mm) ureteral stones if active removal is not indicated. It is important to understand the natural history of ureteric stone disease to help counsel patients with regards to their likelihood of stone passage and anticipated time frame with which they could be safely observed. We aimed to conduct a systematic review to better establish the natural history of stone expulsion. Methodology Literature search was performed using Cochrane and PRISMA guidelines. Outcome measures were patient and stone demographics, expulsion rates, expulsion times, side effect of the medication. A cumulative analysis, with subgroup analysis performed on stone location and size. The results were depicted as percentages and an intention to treat basis was used. Results The literature search identified 70 studies and total of 6642 patients, with a median age of 46 and range of 18-74 years. Overall 64% patients successfully passed their stones spontaneously. About 49% of upper ureteric stones, 58% of mid ureteric stones, and 68% of distal ureteric stones passed spontaneously. Almost 75% of stones &lt;5mm and 62% of stones ≥5mm passed spontaneously. The average time to stone expulsion was about 17 days (range 6-29 days). Nearly 5% of participants required rehospitalisation due to a deterioration of their condition and only about 1% of patients experienced side effects from analgesia provided. Conclusion We believe this current review is the largest study for the evaluation of natural history of ureteric stones. The evidence suggests that ureteric stones will pass without intervention in 64% of patients, however this varies from nearly 50-75% depending on the size and location, in the span of 1-4 weeks.</p

HaEmaturia After Transurethral resection of bladder Tumour (HEATT): A multicentre, regional collaborative analysis of factors associated with emergency re-admission with haematuria following TURBT

Objective: To calculate the re-admission rate with haematuria within 30 days of elective transurethral resection of bladder tumour (TURBT), and identify factors associated with this. Materials and Methods: This was a multicentre, retrospective audit, identifying all adult patients over the age of 16 who underwent elective TURBT between 1 September and 30 November 2019. Data were collected from medical records and operation notes on patient demographics, intra-operative factors and post-operative management. Primary outcome measure was the proportion of patients emergently re-admitted with haematuria. Secondary outcome measures were the re-operation rate for haematuria, and the rate of new acute thrombotic event (TE). Fisher’s exact test was used to calculate p values within subgroups for re-admission rates. Results: 443 patients from 12 hospitals were included. Median age was 75 years (17–99). 15 patients (3.4%) were re-admitted with haematuria. Subgroup analysis demonstrated higher rate of re-admission for pre-existing antithrombotic agents (ATAs) (2.0% vs. 6.1%, p = 0.046), increased for non-Aspirin ATAs (10.5%, p = 0.0015). 52% of non-Aspirin ATAs were restarted within 48 hours of surgery; post-operative plan for restarting was not documented in 22.1%. One patient (0.23%) developed acute TE (pulmonary embolus). Conclusion: Pre-existing use of non-Aspirin ATAs is associated with increased risk of post-TURBT haematuria, with variable practice in post-operative recommencement. Level of evidence: Level