Objective: The aim of this study is to determine the relationship between each of the three dimensions of a ureteric stone and the passage rate and to identify ureteric stones with an oval/elongated shape and determine whether the stone passage rate was most closely related to any of the three stone dimensions. Materials and Methods: A retrospective study of all patients who had a computed tomography scan with renal colic protocol at our hospital between January 1, 2016 and June 30, 2017. The maximum axial diameter, axial width, maximum coronal length and location of all stones were recorded. Patients were followed up for at least six months to ensure that the stones had been expelled or surgically removed. Results: Ninety patients spontaneously passed their ureteric calculus, and 80 patients received surgery in this study. If the patients who received surgery within three days of diagnosis were excluded, the spontaneous stone passage rate was 81.1%. Of the 90 patients with spontaneous stone passage, 38.9%, 15.6% and 6.7% patients had stones with at least a 1.0, 1.5 and 2.0 mm difference between the maximum axial and coronal dimensions, respectively. Within the subset of calculi that passed within 90 days, these elongated calculi required between 3 and 6 less median days to pass than the more rounded calculi, although this was not statistically significant. Conclusion: This study showed that in isolation, the individual dimension of a ureteric calculus did not significantly affect the time required to pass the calculus spontaneously. Elongated-shaped calculi were not common in this study.

Introduction & Objectives: IOK is a surgical emergency requiring urgent decompression with either retrograde insertion of a JJ ureteric stent (JJ stent) or percutaneous nephrostomy (PCN) tube. Efficacy of both techniques is established but specific indication for preference of either is lacking. We sought to characterize the patterns of use and compare outcomes of patients with infected obstructed kidney treated by JJ stent placement or PCN. Methods: IOK was defined as patients with a dilated urinary tract on CT and systemic inflammatory response syndrome (SIRS). A retrospective review of all patients who presented with IOK and had an emergent insertion of a PCN or a JJ stent at Fiona Stanley Hospital between February 2015 to July 2017 was performed. Our institution has a 24-h urology and interventional radiology service. Choice of intervention was dependent on preference of the treating clinicians. Patient demographics, cause of renal tract obstruction, laboratory markers, clinical observations, ICU admission, length of stay and procedure failure rates were compared. Results: 194 patients underwent either PCN or JJ stent insertion for IOK. 48 (24.7%) patients were treated with PCN and 146 (75.3%) had a JJ stent inserted. Mean age of patients was 63 for the PCN group and 58 for the JJ stent group (p = 0.07). The average length of stay in hospital was 10.75 days for the PCN group and 6.75 days for the JJ stent group (p-value <0.01). 48% of patients in the PCN group were admitted to ICU compared to 14% of patients in the JJ stent group (p value <0.01). Mean APACHE II score for the PCN group was 13.7 compared to 10.6 for the JJ stent group (p-value <0.01). 3 (2%) patients had failed attempt at retrograde JJ stent insertion and required PCN insertion instead. 2 patients had accidental removal of PCN tubes and required reinsertion. 2 patients that underwent PCN had in-hospital death. 81.5% of patients that underwent JJ stent insertion and 60.5% of PCN patients had obstruction secondary to urolithiasis. Conclusions: PCN and JJ stent are effective in the setting of infective obstructed kidney with low failure rates. Patients that underwent PCN insertion had longer LOS, increased likelihood for ICU admission and were more acutely ill at the time of presentation. This study suggests that older, sicker patients are more commonly treated with PCN over JJ stent in our institution as opposed to increased safety of JJ stent over PCN. Large prospective RCTs in this acute setting, though challenging to perform, are required to better define the optimum management of these patients.