STUDY TYPE: Therapy (case series). LEVEL OF EVIDENCE: 4. OBJECTIVE: To determine the implementation of medical expulsive therapy (MET) for ureterolithiasis in one tertiary-care emergency room (ER); referral patterns in the surgical and metabolic follow-up of ureterolithiasis were also assessed. PATIENTS AND METHODS: In this retrospective review we identified 556 patients with ureterolithiasis in the ER at our centre between 2005 and 2007. Of these, 131 patients met inclusion criteria, including first-time stone formers and no urological visit within the previous 5 years. ER records were reviewed and telephone interviews conducted to determine if MET was used, if the patient was referred to a urologist, if surgery was ultimately required, and if there was ultimately a metabolic evaluation. RESULTS: The mean (range) stone size was 4.2 (2-10) mm. Ten patients were admitted directly from the ER and 121 were discharged home. Of the 121 discharged patients, 48 (40%) were prescribed MET. In all, 46 patients received tamsulosin 0.4 mg and two received doxazosin 2 mg; no patient was prescribed steroids. The mean size of passed stones was statistically significantly lower than that of stones that did not pass (P < 0.05). Patients prescribed MET had a 23% chance of needing surgery, vs 32% in those not prescribed MET (P < 0.05). Seventy-one (61%) patients were followed up by a urologist, 27 (23%) by a primary-care physician, and eight (7%) had no further follow-up. Ultimately, 31 (23%) patients had a metabolic evaluation and it was abnormal in 29 (95%). CONCLUSIONS: In this single-institution ER experience, 40% of patients with symptomatic ureterolithiasis were treated with MET on discharge from the ER. Our data also show that only patients referred to a urologist received a metabolic evaluation. This is notable given that the vast majority of those evaluated were found to have a correctable abnormality.
STUDY TYPE: Therapy (case series). LEVEL OF EVIDENCE: 4. OBJECTIVE: To determine the implementation of medical expulsive therapy (MET) for ureterolithiasis in one tertiary-care emergency room (ER); referral patterns in the surgical and metabolic follow-up of ureterolithiasis were also assessed. PATIENTS AND METHODS: In this retrospective review we identified 556 patients with ureterolithiasis in the ER at our centre between 2005 and 2007. Of these, 131 patients met inclusion criteria, including first-time stone formers and no urological visit within the previous 5 years. ER records were reviewed and telephone interviews conducted to determine if MET was used, if the patient was referred to a urologist, if surgery was ultimately required, and if there was ultimately a metabolic evaluation. RESULTS: The mean (range) stone size was 4.2 (2-10) mm. Ten patients were admitted directly from the ER and 121 were discharged home. Of the 121 discharged patients, 48 (40%) were prescribed MET. In all, 46 patients received tamsulosin 0.4 mg and two received doxazosin 2 mg; no patient was prescribed steroids. The mean size of passed stones was statistically significantly lower than that of stones that did not pass (P < 0.05). Patients prescribed MET had a 23% chance of needing surgery, vs 32% in those not prescribed MET (P < 0.05). Seventy-one (61%) patients were followed up by a urologist, 27 (23%) by a primary-care physician, and eight (7%) had no further follow-up. Ultimately, 31 (23%) patients had a metabolic evaluation and it was abnormal in 29 (95%). CONCLUSIONS: In this single-institution ER experience, 40% of patients with symptomatic ureterolithiasis were treated with MET on discharge from the ER. Our data also show that only patients referred to a urologist received a metabolic evaluation. This is notable given that the vast majority of those evaluated were found to have a correctable abnormality.
Authors: Carter Boyd; Kyle Wood; Dustin Whitaker; Omotola Ashorobi; Lisa Harvey; Robert Oster; Ross P Holmes; Dean G Assimos Journal: Rev Urol Date: 2018