Emergency Room Follow-up Trends In Urolithiasis: Single-center Report

Main Category: Urology / Nephrology
Article Date: 10 Sep 2009 - 4:00 PDT

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UroToday.com - Two Mid-Western studies on the emergency department (ED) management of patients with renal colic suggest that our ED colleagues would benefit from an educational update on this clinical problem.

While the majority of patients are assessed with noncontrast CT imaging in the ED, there was a wide discrepancy in the understanding of the spontaneous stone passage rate for different stone sizes by ED physicians. Surprisingly, only 15% of ED actually have guidelines for the management of renal colic and only 58% of these guidelines include the use of alpha blockers. The ED physicians with <5 years of practice are more likely to use alpha blockers for these patients suggesting that they have had more up-to-date education.

Although several prospective randomized studies have not demonstrated parenteral fluid bolus to be of any benefit in stone passage rates or analgesia requirements in patients with renal colic, this is still a widely utilized ED practice - with ketorolac and morphine most commonly utilized for pain management.

Once discharged from the ED, between 72% and 86% of renal colic patients undergo urological consultation or follow-up for their stone disease. These observations should encourage all urologists to offer evidence-based educational sessions for our local ED physicians on renal stone emergency presentation, management and follow-up which will ultimately improve patient care and outcome.

Sterrett SP, Moore NW, Nakada SY
Urology. 2009 Jun;73(6):1195-7
doi: 10.1016/j.urology.2008.07.057

See Also:

Emergency room management of ureteral calculi: Current practices
Phillips E, Kieley S, Johnson EB, Monga M
J Endourol. 2009 Jun;23(6):1021-4
doi:10.1089/end.2008.0615

Written by UroToday.com Contributing Editor Elspeth M. McDougall, MD, FRCSC, MHPE

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