In the management of ureteric calculi, which parameter best predicts the need for urological intervention (ureteroscopy or ESWL) over expectant management according to the EAU guidelines?
- A Patient age and sex
- B Urine pH below 6.0
- C Stone size and location (distal ureteric stones ≤6 mm vs >6 mm) ✓
- D Presence of microhematuria
Explanation
According to EAU guidelines, stone size and location are the primary determinants for intervention versus expectant management. Distal ureteric stones ≤6 mm have a high spontaneous passage rate (~80%) and are managed conservatively with medical expulsive therapy (alpha-blockers) if no complications. Stones >6 mm or proximal stones have lower passage rates and require active intervention. Obstruction, infection (sepsis), intractable pain, or solitary kidney are absolute indications for intervention regardless of size. Microhematuria and urine pH are diagnostic aids, not intervention predictors.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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