Spontaneous ureteral stone passage: a novel and comprehensive nomogram

Area of Science:

• Urology
• Emergency Medicine
• Medical Imaging

Background:

• Ureteral stones represent a significant economic and medical burden in emergency departments.
• Current management strategies for ureteral stones range from conservative observation to surgical intervention.
• Predictors for spontaneous ureteral stone passage (SSP) remain incompletely understood, necessitating improved decision-making tools.

Purpose of the Study:

• To develop and validate a novel nomogram for predicting ureteral spontaneous stone passage (SSP).
• To incorporate the serum neutrophil-to-lymphocyte ratio (NLR) as a key predictor in the nomogram.
• To provide a clinical tool to guide management decisions for patients with ureteral stones.

Main Methods:

• Retrospective review of 1186 patients with ureteral stones (≤10 mm) presenting to the emergency department.
• Data collection included demographics, clinical findings, laboratory results, and non-contrast CT scans.
• A multivariate logistic regression model was used to derive the nomogram, incorporating NLR, and validated on a separate cohort.

Main Results:

• A stone size ≥7 mm was the strongest predictor of SSP failure (OR=9.47).
• Elevated NLR (≥3.14) increased the odds of stone retention (OR=2.17).
• The nomogram demonstrated good predictive performance with an AUC of 0.804 for SSP failure.

Conclusions:

• A novel nomogram effectively predicts spontaneous ureteral stone passage (SSP).
• The nomogram integrates clinical, radiological, and laboratory parameters, including NLR.
• This tool can assist clinicians in making informed management decisions for ureteral stones.