2256 MEDICAL EXPULSIVE THERAPY UTILIZATION IN PATIENTS PRESENTING WITH URETEROLITHIASIS

Abstract

You have accessJournal of UrologyStone Disease: Evaluation & Medical Management (II)1 Apr 20132256 MEDICAL EXPULSIVE THERAPY UTILIZATION IN PATIENTS PRESENTING WITH URETEROLITHIASIS Aaron Lay, Jeffrey Leow, Benjamin Chung, and Steven Chang Aaron LayAaron Lay Boston, MA More articles by this author , Jeffrey LeowJeffrey Leow Boston, MA More articles by this author , Benjamin ChungBenjamin Chung Stanford, CA More articles by this author , and Steven ChangSteven Chang Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2165AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Randomized controlled trials have demonstrated the efficacy of medical expulsive therapy (MET) for promoting passage of ureteral stones. Though this is well known among urologists, there has been concern regarding its utilization in the acute setting, when these patients may not be treated by urologists. We sought to measure utilization rates of MET in patients presenting with acute ureterolithiasis. METHODS We captured all patients who had a primary diagnosis of ureterolithiasis between January 1, 2003, and December 31, 2010, based on ICD-9 code 592.1 from Premier Perspective Database (Premier Inc, Charlotte, NC), a nationally representative discharge database that covers 20% of US hospital discharges. Patients who carried diagnosis of ureterolithiasis but did not undergo a surgical procedure were included in the study. Patients who received tamsulosin, nifedipine, and/or predisone were identified by hospital charge billing descriptions. Statistical analyses were performed using STATA. All statistical testing was two-sided and a p-value<0.05 was considered statistically significant. RESULTS There were 2916 patients who had a principal diagnosis of ureterolithiasis but did not undergo a surgical procedure. Patients received tamsulosin 12.4% of the time, while nifedipine use was 1.5% and steroid use was 2.8%. Tamsulosin was more likely used in men, in teaching hospitals, and in recent years. Tamsulosin was also more likely used in the Middle Atlantic States compared to other regions of the country. CONCLUSIONS Even though there are randomized controlled trials that have demonstrated medical expulsive therapy to increase the likelihood of stone passage and faster time to stone passage, MET is underutilized. Our analysis suggests that MET is being used more frequently in recent years, but there is still underuse in the medical community. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e925 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Lay Boston, MA More articles by this author Jeffrey Leow Boston, MA More articles by this author Benjamin Chung Stanford, CA More articles by this author Steven Chang Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...