The disappearance of symptoms in patients with ureteral stones does not mean that the stones are discharged

This article is from the NEJM Journal Watch Follow-Up of Ureteral Stones Smaller Than a Follow-Up Review of Ureteral Stones Less than 9 mm in Diameter By Allan S.
Brett, MD At 1 month, 20% of patients still have ureteral stones ; and about half of them have neither hydronephrosis nor pain
.

A recent study of patients presenting with pain due to ureteral stones found that the absence of pain within the next few weeks does not necessarily mean the stone has passed (NEJM JW Gen Med Jun 1 2018 and J Urol 2018; 199:1011)
.

Now, in another study, investigators studied 220 patients with acute ureteral colic (stone diameter, <9 mm) who did not undergo urological lithotomy
.

Computed tomography (CT) demonstrated the presence of stones; hydronephrosis was present in 81% of cases
.

At follow-up CT approximately 1 month later, 80% of patients had passed the stone and 20% still had the stone
.

Of the 43 patients with still stones, 36 had no pain, 26 had no hydronephrosis, and 23 had neither hydronephrosis nor pain
.

Even among patients with stones less than 5 mm in diameter, 11% still had stones, and half of them had neither hydronephrosis nor pain
.

Comments This study provides more evidence that pain relief does not rule out the presence of ureteral stones
.

In addition, this study shows that patients with persistent kidney stones do not necessarily have hydronephrosis; this observation suggests that renal ultrasonography (which is sensitive in detecting hydronephrosis but not ureteral stones) at follow-up ) will miss some persistent ureteral stones
.

There is no consensus on the optimal imaging strategy for asymptomatic patients who have not had their stones removed; however, such patients clearly require follow-up
.

Reviewed article Jackman SV et al.
Resolution of hydronephrosis and pain to predict stone passage for patients with acute renal colic.
Urology 2022 Jan; 159:48.
(https://doi.
org/10.
1016/j.
urology.
2021.
09.
017 ) NEJM Journal Watch NEJM Journal Watch (NEJM Journal Watch) is published by the NEJM Group.
It invites internationally renowned doctors to review important papers in the medical field to help doctors understand and apply the latest developments
.

"NEJM Frontiers of Medicine" translates several articles every week, publishes them on the app and official website, and selects 2-3 articles and publishes them on WeChat
.

Copyright Information This article was translated, written or commissioned by the NEJM Frontiers in Medicine, jointly created by Jiahui Medical Research and Education Group (J-Med) and The New England Journal of Medicine (NEJM)
.

The full text of the Chinese translation and the included figures are exclusively authorized by the NEJM Group
.

If you want to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn
.

Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal responsibility
.