title: Managing Small Ureteral Stones: A Retrospective Study on Follow-Up, Clinical Outcomes and Cost-Effectiveness of Conservative Management vs. Early Surgery.
abstract: BACKGROUND
  The management of ureteral calculi has evolved over the past decades with the advent of new surgical and medical treatments. The current guidelines support conservative management as a possible approach for ureteral stones sized = 10 mm.
  
  
  OBJECTIVE
  We purport to follow the natural history of ureteral stones managed conservatively in this retrospective study, and attempt to ascribe an estimated health-care and cost-effectiveness, from presentation to time of being stone-free.
  
  
  METHODS
  192 male and female patients with a single ureteral stone sized = 10 mm were included in this study. The clinical and cost-related outcome was analyzed for different stone sizes (0-4, 4-6 and 6-10 mm). The effectiveness of selected follow-up (FU) scans was also analyzed.
  
  
  RESULTS
  Stone size was found to be related to the degree of hydronephrosis and to the likelihood of need for a surgical management. Conservative management was found to be clinically effective, as 88% of the patients did not require surgery for their stone. 96.1% of the patients with a stone 0-4mm managed to expel their ureteral stone. Bigger ureteral stones were found to be more costly. The cost-effectiveness of the single FU scans was found to be related to their efficiency, while the global cost-effectiveness of conservative management vs. early surgery was higher for smaller stones (26.8 vs. 17.32% for stones 0-4 vs. 6-10 mm).
  
  
  CONCLUSIONS
  Conservative management is clinically effective with a significant cost-benefit, particularly for the subgroup of stones sized 0-4 mm, where a need for FU scans is in dispute.
authors.affiliation: Department of Urology, Colchester Hospital University Foundation Trust, Colchester, London, UK.
authors.forename: Aristeidis
authors.initials: A
authors.lastname: Alevizopoulos
authors.affiliation: Department of General Surgery, West Midlesex University Hospital of London, London, UK.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Zosimas
authors.affiliation: Athens University of Economics and Business, Athens, Greece.
authors.forename: Lamprini
authors.initials: L
authors.lastname: Piha
authors.affiliation: Department of Urology, West Midlesex University Hospital of London, London, UK.
authors.forename: Milad
authors.initials: M
authors.lastname: Hanna
authors.affiliation: Department of Urology, West Midlesex University Hospital of London, London, UK.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Charitopoulos
keywords: Conservative management; Cost-effective; Tamsulosin; Ureteral calculus; Urolithiasis