title: Analysis of factors affecting spontaneous expulsion of ureteral stones that may predict unfavorable outcomes during watchful waiting periods: What is the influence of diabetes mellitus on the ureter?
abstract: OBJECTIVE
  The aim of our study was to evaluate the association of several factors with spontaneous stone expulsion, including ureteral stone characteristics (size, location, hydronephrosis, perinephric stranding), types of medications prescribed (α-blocker, low-dose steroid), and other possible demographic and health-history factors (gender, age, serum creatinine, underlying diabetes mellitus [DM], and hypertension).
  
  
  METHODS
  A total of 366 patients with ureteral stones were enrolled. All patients underwent watchful waiting without any invasive procedures. Initial diagnoses of ureteral stones were confirmed by computed tomography scans, which were taken at approximately 1-month intervals to check for stone expulsion. Univariate and multivariate analyses were conducted to identify significant factors that contributed to stone expulsion.
  
  
  RESULTS
  Among 366 patients, 335 patients (91.5%) experienced spontaneous stone passage during a mean follow-up period of 2.95±2.62 weeks. The patients were divided into two groups depending on the success of spontaneous stone passage. Univariate analyses revealed that stone location (p=0.003), stone size (p=0.021), and underlying DM (p<0.001) were significant predictors of stone passage. Multivariate analyses confirmed that stone size (p=0.010), stone location (p=0.008), and underlying DM (p=0.003) were independent predictive factors affecting stone passage.
  
  
  CONCLUSIONS
  Stone size, location, and underlying DM were confirmed to be significant predictive factors for spontaneous passage of ureteral stones. Urologists should consider active procedures, such as shock wave lithotripsy or ureteroscopy, rather than conservative management in patients presenting with proximally located stones, large ureteral stones, or underlying DM.
authors.affiliation: Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: Taesoo
authors.initials: T
authors.lastname: Choi
authors.affiliation: Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: Koo Han
authors.initials: KH
authors.lastname: Yoo
authors.affiliation: Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: Seung-Kwon
authors.initials: SK
authors.lastname: Choi
authors.affiliation: Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: Dong Soo
authors.initials: DS
authors.lastname: Kim
authors.affiliation: Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: Dong-Gi
authors.initials: DG
authors.lastname: Lee
authors.affiliation: Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: Gyeong Eun
authors.initials: GE
authors.lastname: Min
authors.affiliation: Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: Seung Hyun
authors.initials: SH
authors.lastname: Jeon
authors.affiliation: Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: Hyung-Lae
authors.initials: HL
authors.lastname: Lee
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: In-Kyung
authors.initials: IK
authors.lastname: Jeong
mesh_terms: D000328:Adult; D000368:Aged; D048909:Diabetes Complications / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D057832:Watchful Waiting
keywords: Diabetes mellitus; Therapeutics; Ureteral calculi; Urolithiasis