Early or late intervention of upper urinary tract stone disease: What dictates it?

Objective: Urolithiasis is a multifactorial disease that causes symptomatology and needs to be managed depending on various clinical parameters. In this study, we aimed to investigate clinical factors for early operation in patients with uncomplicated symptomatic urolithiasis. Materials and Methods: Medical records of 148 patients who underwent ureterorenoscopic lithotripsy (URS) within 6 weeks of diagnosis of urolithiasis were retrospectively reviewed. The patients were divided into two groups: those operated early (≤3 days, n = 80) and those operated late (≥4 days, n = 68). Data, including age, sex, body mass index, degree of pain assessed with Visual Analog Scale (VAS), radiological and laboratory examinations at the time of admission, along with perioperative surgical data, were recorded. Results: 110 (74.3%) males and 38 (25.7%) females with a median age of 38 years were operated on for uncomplicated ureteral stones. Median time from diagnosis to ureteroscopic intervention was 3 days. Among clinical factors, only the number of readmissions to the emergency room, the mean white blood cell count, the level of microscopic hematuria, and VAS scores of pain at the initial diagnosis were significantly higher in the early operated group ( P < 0.05). Conclusions: Pain is a major clinical factor resulting in earlier URS in uncomplicated upper urinary tract stone disease. First admission to the emergency room due to renal colic with multiple readmissions after diagnosis, high level of microscopic hematuria, and white blood cell counts appear to be significant pain-related factors for earlier operation.