Patients with urolithiasis, including renal and ureteral stones, experience lower urinary tract symptoms (LUTS), including urinary frequency, urgency, and dysuria mimicking cystitis, especially in patients with stones in the lower 1/3 ureter. We aimed to determine the correlation between LUTS and urolithiasis location and size in patients experiencing renal colic.

We conducted a cross-sectional study on patients with urolithiasis referring to the electroshock wave lithotripsy (ESWL) ward. The inclusion criteria were patients over 18 age, sterile urine sample, completion of an International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) questionnaire, and/ or males (ICIQ-MLUTS), and sonography or CT-scan. Patients with recent hospitalization (3 months) and urinary catheter or urinary tract infections at the time of LUTS questionnaire completion were excluded from the study.

Among 308 cases referred for lithotripsy, 194 (63.0%) were male. Of these, 28 cases (9.1%) had DJ stents.  Two hundred thirty-three patients (75.6%) had renal stones, and of these, in 18 cases (5.8%) it was located in the upper, in 47 individuals (15.3%) in the mid, in 81 patients (26.3%) in the lower, and in 86 patients (27.9%) in the pelvis of kidneys. While ureteral stones were detected in 79 cases (25.6%), in 45 patients (14.6%), it was located at proximal, in 22 cases (7.1%) at mid, and in 12 patients (3.9%) in the distal ureter. The prevalence of LUTS is illustrated in Table 1. 

In 39 cases out of 79 individuals who had proximal ureteral stones, 49.4% did not report any urgency, while in the 12 patients (15.2%), this symptom occurs sometimes. Ten patients reported it most or all of the time. The prevalence of LUTS symptoms with the location of urolithiasis and its association with the symptoms are summarized in Table 2. Although most of the cases with urethral stones had no LUTS, according to Fisher's Exact Test results, there was a significant association between the location of the urethral stone and urinary urgency, dysuria, straining, enuresis, intermittency, weak stream, and incomplete emptying. 
We evaluated any correlation between the location of stones and LUTS. In terms of renal stones, there was no correlation between the stone’s location and LUTS. However, in ureteral stones, there was a correlation between its location and urgency (spearman’s Rho correlation coefficient: 0.199, p<0.001), nocturia (CC: 0.142, p=0.013), dysuria (0.138, p=0.015), enuresis (CC: 0.114, p=0.046), straining (CC: 0.123, p=0.030), intermittency (0.154, p=0.007), and weak stream (CC: 0.161, p=0.005). 
The presence of stent was correlated with urinary frequency (CC: 0.179, p=0.002), urgency (CC: 0.180, p=0.001), pain (CC: 0.166, p=0.003), and dysuria (CC: 0.207, p<0.001). There was no correlation between the stone’s width or height and LUTS.

Our results showed a correlation between ureteral stone location and LUTS. In patients with a stent, there was a correlation between its presence and urinary frequency, urgency, pain, and dysuria. There was no correlation between the renal stone’s location or the width or height of all urinary tract stones and LUTS. However, it will not be easy to judge the study's outcomes regarding the small sample size, and further studies with a large sample size are recommended.

Although our results showed a correlation between stone location and LUTS, more than 70% of referred patients for ESWL had no lower urinary tract symptoms, and LUTS is not a prevalent finding in these patients. However, it will not be easy to judge the study's outcomes regarding the small sample size, and further studies with a large sample size are recommended.