The Copetti Sign in Suspected Renal Colic: Association with Distal Ureteral Stones in a Prospective Pilot Cohort

Background: Renal colic is a common emergency department (ED) presentation requiring rapid and accurate diagnosis. Point-of-care ultrasound (POCUS) is a fast, radiation-free alternative to CT. The Copetti sign-a rhythmic anteroposterior oscillation of the affected kidney-has been proposed as a dynamic sonographic marker of distal ureteral stones. Methods: In this prospective observational study (June-September 2025), 44 adult patients with suspected renal colic were enrolled at a single-center ED in Baggiovara, Modena, Italy. All underwent standardized POCUS to detect the Copetti sign prior to confirmatory imaging. Clinical, laboratory, and sonographic variables were collected. Associations between the Copetti sign, stone location, stone size, hydronephrosis, urinoma, and management strategy were explored. Associations with conservative management were considered exploratory. Results: The Copetti sign was identified in 70.5% of patients and was significantly associated with distal ureteral stones (74.2% vs. 25.8%, p = 0.005). Copetti-positive patients were more often managed conservatively (77.4% vs. 38.5%, p = 0.019), although this likely reflects the underlying clinical-imaging phenotype and local treatment decisions rather than a validated prognostic endpoint. Conclusions: In this prospective pilot cohort, the Copetti sign was frequently observed and was strongly associated with distal ureteral stone location. Copetti-positive patients were also more often managed conservatively, although this should be interpreted as an exploratory association reflecting clinical decision-making rather than a validated prognostic endpoint.