Journal of endourology
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Introduction and Objective: Eighty percent of patients with distal ureteral stones <10 mm will ultimately pass the stone under conservative care. Nonetheless, some may experience related morbidity before surgical intervention is performed. Our study aims to find predictive variables for surgical intervention. ⋯ Multivariate analysis showed stone diameter, stone-to-UVJ distance, and pain duration at presentation to be independently predictive for intervention. Receiver operating characteristics curve analysis identified stone size >4 mm, stone-to-UVJ distance >4 mm, and pain duration >4 days to be the most significant cutoff points for patient risk stratification-"Rule of 4's." Further analysis showed that the prevalence of intervention among patients with 0, 1, 2, and 3 risk factors was 4.3%, 22.1%, 45%, and 66.7%, respectively. Conclusions: Stone size, stone distance from the UVJ, and pain duration play a significant role in predicting surgical intervention. "Rule of 4's" may aid in early recognition of patients who will ultimately undergo intervention and omit the burden of nonfavorable expectant management.