Warm sitz bath as an adjunctive therapy for distal ureteral calculi ≤5 mm: a prospective study

To evaluate the efficacy of warm sitz bath (WSB) as an adjunctive conservative therapy for patients with distal ureteral calculi (DUC) ≤5 mm.

A total of 131 eligible patients with DUC ≤5 mm were prospectively randomized into the WSB group or the control group. Patients in the WSB group received standardized WSB (40-42 °C, 15-20 min, once daily), whereas those in the control group received no expulsive intervention. All patients were required to complete a 4-week follow-up after enrollment.

Of the 131 patients, 121 completed follow-up and were included in the final analysis, including 59 patients in the WSB group and 62 patients in the control group. Baseline characteristics were comparable between the two groups (all P > 0.05). The WSB group demonstrated significantly shorter stone expulsion time compared with the control group (9.3 ± 2.9 days vs. 14.3 ± 4.2 days, P < 0.001). Stone expulsion rates (SER) at week 1 (40.7% vs. 21.0%, P = 0.019) and week 2 (81.4% vs. 61.3%, P = 0.015) were significantly higher in the WSB group, whereas no significant difference was observed in the 4-week stone expulsion rate (93.2% vs. 87.1%, P = 0.260). The WSB group also showed significantly fewer daily pain episodes (0.8 ± 0.3 vs. 1.3 ± 0.4, P < 0.001), lower post-treatment VAS scores (3.1 ± 1.0 vs. 4.2 ± 1.7, P < 0.001), and lower analgesic requirements (4.1 ± 1.5 vs. 8.4 ± 3.1, P < 0.001). No significant differences in adverse events were observed between the two groups.

WSB may shorten the expulsion time of DUC ≤5 mm and reduce pain burden and analgesic requirements; however, it does not significantly improve the overall 4-week SER.