J Korean Soc Emerg Med.  2019 Feb;30(1):77-82. 10.0000/jksem.2019.30.1.77.

Clinical significance of microscopic hematuria and hydronephrosis in ureteral calculi patients visiting emergency department

Affiliations
  • 1Department of Emergency Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea. jchan98@hanmail.net
  • 2Department of Urology, Keimyung University Dongsan Medical Center, Daegu,Korea.
  • 3Department of Urology, Dongguk University College of Medicine, Gyeongju, Korea.

Abstract


OBJECTIVE
This study examined the clinical significance of microscopic hematuria and grade of hydronephrosis in ureteral calculi patients visiting the emergency department (ED).
METHODS
The EDs of two medical centers were reviewed retrospectively from August 1, 2012 to July 31, 2017. The total ureteral calculi patients were 2,069 and 1,593 patients were analyzed after exclusion. The normal range of microscopic hematuria in both medical centers was 0-5/high power field (HPF) of red blood cell in urinalysis. Therefore, microscopic hematuria more than 5/HPF was defined as positive. The size of the stone, grade of hydronephrosis (normal, mild, moderate, and severe) and location of ureteral calculi in the non-contrast abdomen and pelvis computed tomography (CT) was measured by one person at each medical center using same method. The patients with or without microscopic hematuria and grade of hydronephrosis were then compared.
RESULTS
The median size of the ureteral calculi patients without and with microscopic hematuria was 5.4 mm (range, 3.8-9.0 mm) and 4.0 mm (range, 3.0-5.8 mm) (P < 0.001). The patients grouped as normal to mild, and moderate to severe hydronephrosis, without microscopic hematuria was 191 (16.5%) and 91 (20.9%), respectively. On the other hand, microscopic hematuria was 966 (83.5%) and 345 (79.1%) (P=0.042). According to the location of ureteral calculi, with and without microscopic hematuria was 81.9% and 18.1% in the upper ureter, 82.9% and 17.1% in the mid ureter, and 82.6% and 17.4% in the lower ureter, respectively (P=0.935).
CONCLUSION
The median size of the stone and grade of hydronephrosis were related to microscopic hematuria but the location of the ureteral calculi was not related. Therefore, in cases without microscopic hematuria in suspected ureteral calculi, clinicians should check the abdomen and pelvis CT for an accurate diagnosis and treatment of ureteral calculi.

Keyword

Ureteral calculi; Hematuria; Hydronephrosis

MeSH Terms

Abdomen
Diagnosis
Emergencies*
Emergency Service, Hospital*
Erythrocytes
Hand
Hematuria*
Humans
Hydronephrosis*
Methods
Pelvis
Reference Values
Retrospective Studies
Ureter*
Ureteral Calculi*
Urinalysis
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