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Resolution of pain following ureteroscopic treatment of small, non-obstructing renal stones.
Ying Jura, M.D., Susan Lahey, MD, Brian H. Eisner, MD, Stephen P. Dretler, MD.
Massachusetts General Hospital, Boston, MA, USA.

BACKGROUND:
Traditionally, it has been thought that renal colic is caused by obstruction of the urinary tract, and this commonly occurs from calculi that obstruct the ureter or ureteropelvic junction. Many patients imaged for renal colic, however, are found to have no other source for their pain other than small, non-obstructing renal stones. We hypothesize that small non-obstructing renal stones may also cause pain and that treatment of these stones may relieve this pain.
METHODS:
A retrospective chart review was performed to identify patients with non-obstructing renal stones, complaints of renal colic or flank pain, and treatment by ureteroscopy. Patients with pain and non-obstructing stones measuring less than or equal to 4mm in diameter within the renal pelvis or calyx were included in the study. Exclusion criteria included anatomic abnormalities, such as duplex collecting system and calyceal diverticulum. Patients were contacted and completed a follow-up questionnaire regarding pre- and postoperative pain and quality of life (QOL).
RESULTS:
Thirteen patients were included in the analysis. Mean stone diameter was 3mm (±0.7). Following ureteroscopic treatment, 11 (85%) patients reported complete resolution of pain and 2 (15%) patients reported partial resolution. Complete or partial resolution was reached after an average of 16 days (±10). Twelve patients were able to describe pre- and postoperative QOL and of these, 8 (67%) had improved QOL, 4 (33%) had no change, and none reported worsening. Follow-up imaging was available in 10 patients with the following results: stone free in 6 (60%), reduction in stone size in 3 (30%), and stone unchanged in 1 (10%).
CONCLUSIONS:
Ureteroscopic treatment of small, non-obstructing renal stones associated with pain achieved resolution of pain in all patients and improvement in quality of life in a majority of patients. Patients who present with small stones and pain may be counseled that ureteroscopy may relieve their symptoms.


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