1
|
Bapir R, Fakhralddin SS, Aghaways I, Muhammed BO, Rahim HM, Fattah FH, Ismael BO, Ali RE, Hamahussein KF, Kakamad FH, Salih RQ, Mohammed SH, Abdalla BA. Predictive value of inflammatory markers for the spontaneous passage of Ureteral stones: a comprehensive systematic review with meta analysis. Urolithiasis 2024; 52:98. [PMID: 38907797 DOI: 10.1007/s00240-024-01590-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/06/2024] [Indexed: 06/24/2024]
Abstract
Urolithiasis is a common disease that affects approximately one-fifth of the global population. This systematic review explores the predictive role of inflammatory markers for the spontaneous passage of ureteral stones. The literature was systematically searched via Google Scholar, PubMed/MEDLINE, the Cochrane Library, Science Direct, CINAHL, Web of Science, and EMBASE databases to identify papers published until 2023. Overall, 26 articles were identified, of which 10 were excluded. The remaining 16 papers reported 2,695 patients (1,723 males and 972 females), with 1,654 (61.37%) experiencing spontaneous stone passage (SSP) and 1,041 (38.63%) not experiencing it (non-SSP). Stones located in the upper part of the ureter were less likely to pass spontaneously (152/959, 15.94% in the SSP group vs. 180/546, 32.48% in the non-SSP group; p < 0.001). Mid-ureteral stones were present in 180/959 (18.75%) of the SSP group compared to 84/546 (14.52%) of the non-SSP group (p = 0.0974). Lower ureteral stones were more likely to pass spontaneously, with 627/959 (63.31%) in the SSP group compared to 282/546 (49.36%) in the non-SSP group (p < 0.001). No significant correlation was found between most inflammatory markers and SSP (p > 0.05). However, procalcitonin levels were lower in the SSP group compared to the non-SSP group (132.7 ± 28.1 vs. 207 ± 145.1, respectively) (p < 0.001). This systematic review has revealed that except procalcitonin, most inflammatory markers do not offer significant predictive capability for ureteral SSP.
Collapse
Affiliation(s)
- Rawa Bapir
- Department of Urology, Sulaymaniyah Surgical Teaching Hospital, Sulaymaniyah, 46001, Iraq
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, 46001, Iraq
- Kscien Organization for Scientific Research, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan, 46001, Iraq
| | - Saman S Fakhralddin
- Department of Urology, Sulaymaniyah Surgical Teaching Hospital, Sulaymaniyah, 46001, Iraq
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, 46001, Iraq
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaimani, Kurdistan, 46001, Iraq
| | - Ismaeel Aghaways
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaimani, Kurdistan, 46001, Iraq
| | - Bryar O Muhammed
- Scientific Affairs Department, Smart Health Tower/Raparin, Sarkapkan Street, Sulaimani, Kurdistan, 46001, Iraq
| | - Hawbash M Rahim
- Kscien Organization for Scientific Research, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan, 46001, Iraq
- Medical Laboratory Science Department, College of Health Sciences, University of Human Development, Sulaymaniyah, Kurdistan Region, 46001, Iraq
| | - Fattah H Fattah
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, 46001, Iraq
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaimani, Kurdistan, 46001, Iraq
| | - Barzan O Ismael
- Scientific Affairs Department, Smart Health Tower/Raparin, Sarkapkan Street, Sulaimani, Kurdistan, 46001, Iraq
| | - Rebaz E Ali
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, 46001, Iraq
| | - Karokh F Hamahussein
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, 46001, Iraq
| | - Fahmi Hussein Kakamad
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, 46001, Iraq.
- Doctors City, Building 11, Apartment 50, Sulaimani, Iraq.
| | - Rawezh Q Salih
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, 46001, Iraq
- Kscien Organization for Scientific Research, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan, 46001, Iraq
- Biology Department, College of Science, University of Sulaimani, Kurdistan, 46001, Iraq
| | - Shvan H Mohammed
- Kscien Organization for Scientific Research, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan, 46001, Iraq
| | - Berun A Abdalla
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, 46001, Iraq
- Kscien Organization for Scientific Research, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan, 46001, Iraq
| |
Collapse
|
2
|
Ramasamy V, Aarthy P, Sharma V, Singh Thakur A. Role of inflammatory markers and their trends in predicting the outcome of medical expulsive therapy for distal ureteric calculus. Urol Ann 2022; 14:8-14. [PMID: 35197696 PMCID: PMC8815354 DOI: 10.4103/ua.ua_139_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
Objective: Symptomatic ureteric stones cause surrounding inflammation-promoting obstruction. C-reactive protein (CRP), white blood cell count (WC), and neutrophil percentage (NP) tend to rise after inflammatory response. Monitoring response during the course of medical expulsive therapy (MET) may help in deciding early intervention, thereby decreasing morbidity. We assessed the role and trends of these markers in predicting the outcome of MET. Materials and Methods: One hundred and ninety-two patients with distal ureteric calculus of size >5 mm were included in this prospective study from April 2017 to March 2018 after ethical committee approval. CRP, NP, and WC were measured on day 1, 7, and 14 of MET, and analysis was done. Results: On univariate analysis, stone size and mean values of CRP, WC, and NP on day 1, 7 and 14 in stone nonpassers were significantly higher compared to stone passers (P < 0.05). Receiver operator curve analysis showed area under the curve value of 0.798 (P = 0.001) for CRP and cut off value determined was 1.35 mg/dL. Multivariate analysis of different variables showed significant association of higher CRP (>1.35 mg/dL) and larger stone size (>7 mm) with MET failure. Decreasing trend of CRP was seen in both groups, but values were higher in stone nonpassers. WC and NP showed decreasing trend in stone passers but persistently high in stone nonpassers. Conclusions: Higher CRP and larger stone size were associated with failure of MET. WC and NP showed decreasing trend in stone passers and persistently higher in nonpassers, which may potentially predict failure of MET, however, their role need to be further studied.
Collapse
|
3
|
Can ureteral wall thickness (UWT) be used as a potential parameter for decision-making in uncomplicated distal ureteral stones 5-10 mm in size? A prospective study. World J Urol 2021; 39:3555-3561. [PMID: 33738575 DOI: 10.1007/s00345-021-03608-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 01/25/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To evaluate the correlation between ureteral wall thickness (UWT) and stone passage (SP) and its cut-off value in distal uncomplicated ureteral stones. PATIENTS AND METHODS In the prospective study from January 2019 to January 2020 at a tertiary care hospital, we reviewed 212 patients aged above 18 years with single, symptomatic, radiopaque, and distal ureteric stone sized 5-10 mm, who were treated with MET (Silodosin 8 mg once daily) until SP or a maximum of 4 weeks. There were 2 groups: responders and non-responders. Demographic data of the patients and all stone radiological parameters including stone size, laterality, density, UWT, the diameter of the ureter proximal to the stone (PUD), and the degree of hydronephrosis were recorded and compared between the 2 groups. RESULTS There were 126 (59.4%) in the responder group and 86 (40.6%) in the non-responder group. On univariate analysis, gender, stone density, stone size, PUD, UWT, and the degree of hydronephrosis were significant factors for stone passage. However, using multivariate analysis, only UWT and the degree of hydronephrosis were significant. ROC analysis showed that 3.75 mm is the cut-off value for UWT, with 86% and 87.3% sensitivity and specificity, respectively. CONCLUSIONS UWT and hydronephrosis can be used as potential predictors for SP and can help with decision-making in patients with uncomplicated 5-10 mm lower ureteric stones.
Collapse
|
4
|
Jain A, Sreenivasan SK, Manikandan R, Dorairajan LN, Sistla S, Adithan S. Association of spontaneous expulsion with C-reactive protein and other clinico-demographic factors in patients with lower ureteric stone. Urolithiasis 2019; 48:117-122. [PMID: 31025078 DOI: 10.1007/s00240-019-01137-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 04/19/2019] [Indexed: 01/24/2023]
Abstract
The purpose of our study is to analyze the definitive relation of C-reactive protein (CRP) and other factors with the spontaneous stone passage in patients with distal ureteric calculus of 5-10 mm and to calculate the risk of failure of expectant management in patients. 185 patients of ureteric colic, who were subjected to medical expulsive therapy (MET), were included prospectively from August 2016 to May 2018 and followed up for 4 weeks. Patients were divided into two groups. Group A included successful spontaneous passage patients and group B included failure in the same. The parameters analyzed were age, gender, longitudinal and transverse diameter of stone, CRP, total leucocyte count, ureteric diameter and hydroureteronephrosis (HUN). We performed univariate and multivariate analysis. Receiver operating characteristics curve was used to determine the cutoff value for significantly associated variables. 122 (65.90%) and 63 (34.10%) patients were included in group A and B, respectively. In univariate analysis, CRP, longitudinal and transverse diameter of stone, HUN, proximal and distal ureteric diameters were statistically significant. However, in multivariate analysis, only negative CRP (p = 0.002), smaller longitudinal diameter of stone (p < 0.001) and absence of HUN (p = 0.005) were significantly associated with successful expulsion. Cutoff for CRP was 0.41 mg/dl and longitudinal diameter was 6.7 mm. The success rate in the group of patients with no risk factor was 96.7% and with all three risk factors was 16.7%. Patients with a longitudinal diameter of stone > 6.7 mm, HUN, and CRP > 0.41 mg/dl should be considered for early intervention. The success rate of MET can be increased to 86% after exclusion of patients with all three risk factors.
Collapse
Affiliation(s)
- Amit Jain
- Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Pondicherry, Puducherry, 605006, India
| | - Sreerag Kodakkattil Sreenivasan
- Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Pondicherry, Puducherry, 605006, India.
| | - Ramanitharan Manikandan
- Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Pondicherry, Puducherry, 605006, India
| | - Lalgudi Narayanan Dorairajan
- Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Pondicherry, Puducherry, 605006, India
| | - Sujatha Sistla
- Department of Microbiology, JIPMER Pondicherry, Puducherry, 605006, India
| | - Subathra Adithan
- Department of Radiodiagnosis, JIPMER Pondicherry, Puducherry, 605006, India
| |
Collapse
|