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Can a stone obstructing the ureter cease to cause pain?
Natalia Hernandez, MD, Yan Song, MD, Sarah Mozafarpour, MD, Brian H. Eisner, MD.
Massachusetts General Hospital, Boston, MA, USA.

Purpose: Follow-up imaging is recommended as follow up for patients who present to the emergency department with ureteral stones and colic, but it often omitted if patients report cessation of pain. The purpose of this study was to evaluate how often a patient’s ureteral colic will cease despite still having a stone obstructing the ureter.
Methods: Thirty-six patients evaluated in an emergency department for ureteral colic and diagnosed with an obstructing ureteral stone who subsequently had follow-up in the urology clinic were retrospective evaluated. Patients who described the cessation of pain 72 hours prior to their office visit and who had follow up imaging were included in the study.
Results: Thirty-six (36) patients were included in the study. Mean patient age was 44.7 years (SD 15.7), gender distribution was 19.4% female:80.6% male, and mean time between visits was 40.1 days (SD 41.6). All patients (100%) reported having no pain for at least 72 hours prior to follow-up appointment, while 31% still demonstrated an obstructing ureteral stone on follow up imaging. Mean stone axial and coronal diameter was not different for patients who had passed their stones versus those who had not (axial diameter = 3.5 mm versus 3.8 mm respectively, coronal diameter = 4.1 mm versus 4.6 mm, p = NS for both).
Conclusions: In this small pilot study, nearly 1/3 of patients with ureteral stones whose pain completely ceased still had obstructing stones lodged in the ureter. We feel that cessation of pain alone does not demonstrated proof of stone passage and recommend some form of follow-up imaging for these patients unless they observe stone passage per urethra.


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