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We know that a painful ureteral stone has passed if the patient brings it to us. But what about patients whose pain resolves but who don't retrieve their stones? In this single-center retrospective study, researchers identified 52 patients who met the following criteria: acute ureteral colic, stone confirmed by imaging, follow-up within several weeks, and no pain during the 72 hours prior to the follow-up visit.
At the follow-up encounters (which occurred an average of 35 days after the acute presentations), 26% of these pain-free patients still had ureteral stones (seen on plain film, ultrasound, computed tomography, or ureteroscopy). Most of these patients did not have microscopic hematuria. Imaging confirmed passage of stones in the remaining 74% of patients.
Hernandez N et al. Cessation of ureteral colic does not necessarily mean that a ureteral stone has been expelled. J Urol 2018 Apr; 199:1011. (https://doi.org/10.1016/j.juro.2017.10.032)
Comment
In this study of patients whose acute ureteral colic resolved but who didn't retrieve their stones, the ureteral stone persisted in about one quarter of patients at 1 month. The authors argue for repeat imaging in such patients, so that those with ongoing obstruction and hydronephrosis can be identified and treated. Among patients who don't pass their stones, it's unclear why pain resolves in some but persists in others.