Audit of Conservative Management of Acute Ureteric Stones and Factors Influencing Treatment Outcome in the Emergency Department

Background: Ureteric stones are a common cause of presentation to the emergency department.Management options include conservative therapy, urinary diversion (ureteric stent /nephrostomy), ureteroscopy, or extracorporeal shockwave lithotripsy.Conservative management is known to have a high success rate in appropriately selected patients.This audit evaluates compliance with evidence-based standards in acute ureteric stones management and identifies factors influencing successful conservative treatment.Methods: This retrospective audit reviewed 143 patients who presented with renal colic to the Emergency Department between January and December 2025 and were offered conservative management.Data collected included patient demographics, laboratory findings, CT parameters, administration of nonsteroidal anti-inflammatory drugs (NSAIDS) and tamsulosin, re-presentation rates and treatment outcomes.The audit benchmarked against NICE guidelines.Data analysis was performed using descriptive statistics and appropriate statistical tests (t-test, Fisher's exact test and Mann-Whitney U test) with significance set at p < 0.05.Results: A total of 143 patients met the inclusion criteria.The average age of patients was 48 years.This comprised 101 males (70.63%) and 42 females (29.37%).NSAIDS were administered to 103 patients (72%) at presentation, while 49 patients (34.3%) with distal ureteric stones received tamsulosin.The success rate for the conservative therapy was 93.7%.Seventeen patients (11.9%) re-presented to the emergency department with colic.Among all the variables analyzed (C-reactive protein, white blood cell (WBC), creatinine, perinephric stranding, stone position), stone size was the only variable that showed a significant association with the outcome of conservative treatment (p< 0.05).Conclusion: Our audit findings revealed that NSAIDS and tamsulosin were sub-optimally administered in eligible patients; however, there was a very high rate of successful conservative treatment.Stone size was the only variable that showed significant association with successful conservative treatment.