Ureteral stones frequently cause acute urological emergencies with potential complications such as infection or renal dysfunction. This study evaluates the clinical outcomes of patients admitted with symptomatic ureteral stones, focusing on spontaneous passage rates, complications, and treatment strategies. Our findings aim to guide clinical decision-making by identifying which patients benefit most from observation versus early intervention.

We reviewed the medical records of patients with symptomatic ureteric stones admitted to our institution between January 2022 and December 2023. Stone characteristics were evaluated using non-contrast computed tomography(NCCT). We analyzed clinical and laboratory variables alongside treatment outcomes. The spontaneous passage of the stone is defined as either the patient's observation of the stone in their urine or the absence of the primary stone on follow-up imaging. Continuous variables are presented as median(interquartile range), while categorical variables are presented as count(percentage).

A total of 382 patients were admitted to our institution during the study period. Among the patients, 349 (91.4%) presented with solitary ureteric stones. The median duration of hospitalization was 2 days(IQR 2-3). The median stone size, measured by the longest dimension in mm, was 5(IQR 4-8). Hydronephrosis and emphysematous pyelonephritis were identified in 254(66.5%) and 13(3.4%) of NCCT cases, respectively. A total of 182 patients(47.7%) suffered from complicated urinary tract infections, with 5 patients(2.7%) being admitted to the intensive care unit. For sepsis, emergency drainage of the obstructed urinary system was performed in 19 patients (10.4%) through ureteric stent placement and in 25 patients (13.7%) via percutaneous nephrostomy. A total of 144(37.7%) of patients suffered from acute kidney injury. They were managed with the insertion of a ureteric stent (15, 10.4%), percutaneous nephrostomy (16, 11.1%), emergency ureteroscopic lithotripsy (2, 1.4%) and conservative management (111, 77.1%). Regarding definitive stone treatment, 46 patients(12.1%) underwent extracorporeal shock wave lithotripsy, 83(21.8%) received ureteroscopic lithotripsy, 10(2.6%) were treated with endoscopic combined intrarenal surgery, and 241(63.4%) were managed conservatively. Among the conservatively managed patients, 32(13.1%) did not return for follow-up, while 153(72.5%) passed their ureteric stones by the follow-up date. Large stone size (CI95% 0.83, 0.73 – 0.94, p = 0.003) and proximal ureteric stone (CI 95% 0.31m 0.14 – 0.69, p = 0.004) were the identified as negative predictive factors for spontaneous stone passage.

Most symptomatic ureteric stones could be managed conservatively with a high spontaneous passage rate. These findings support individualized treatment strategies, emphasizing the importance of timely drainage for severe cases while recognizing the effectiveness of observation for uncomplicated stones