# Patient-reported symptoms at follow-up after a ureteral colic attack as an indication of spontaneous stone passage/remaining ureteral stone or presence of urinary tract obstruction

## TL;DR

The study finds that patient-reported symptoms after a kidney stone attack are not reliable for determining if a stone remains or if there is urinary blockage, showing that imaging is still needed.

## Contribution

The study demonstrates that symptoms alone cannot reliably detect ureteral stones or obstruction, emphasizing the continued need for imaging.

## Key findings

- Almost half of patients with a remaining ureteral stone reported no discomfort.
- A significant association was found between higher obstruction severity and reported symptoms.
- Imaging remains necessary to evaluate stone passage after a ureteral colic attack.

## Abstract

Patient-reported symptoms is considered a possible alternative to computed tomography (CT) for the evaluation of remaining ureteral stones at follow-up after a ureteral colic attack.

To investigate patient-reported symptoms at follow-up after a ureteral colic attack in patients with a remaining ureteral stone and to assess the association of symptoms with degree of urinary obstruction.

This was a prospective study of 81 patients (68 men, 13 women; mean age = 59 years; age range = 23–88 years) referred for a follow-up CT after a ureteral colic attack with a remaining unilateral ureteral stone. A dynamic enhanced scan defined urinary obstruction. Stone size was the largest diameter of three multiplanar reformatations (axial, coronal, sagittal). Stone location was registered as proximal, mid-ureter or distal. Symptoms were registered in standardized questionnaires by the patient at the time of the follow-up.

In total, 43/81 (53%) patients reported symptoms. Obstruction of any degree was present in 16 (20%) patients. In 7 (100%) patients with moderate-severe obstruction reported discomfort attributed to the stone. In patients with mild obstruction, 5 (56%) reported discomfort; in patients with no obstruction, 31 (48%) reported discomfort.

Almost half of the patients at follow-up reported no discomfort despite having a stone in the ureter. A significant association was found between a higher degree of obstruction and reported symptoms. Asymptomatic stones and silent partial obstruction could be missed based on reported symptoms. Imaging is still required to evaluate stone passage at follow-up after a ureteral colic attack.