2257 MEDICAL EXPULSION THERAPY IS UNDERUTILIZED IN WOMEN PRESENTING TO AN EMERGENCY DEPARTMENT WITH ACUTE URINARY STONE DISEASE

Abstract

You have accessJournal of UrologyStone Disease: Evaluation & Medical Management (II)1 Apr 20132257 MEDICAL EXPULSION THERAPY IS UNDERUTILIZED IN WOMEN PRESENTING TO AN EMERGENCY DEPARTMENT WITH ACUTE URINARY STONE DISEASE Herman Bagga, Ayesha Appa, Ralph Wang, Thomas Chi, Joe Miller, Jersey Neilson, Rebecca Smith-Bindman, and Marshall Stoller Herman BaggaHerman Bagga San Francisco, CA More articles by this author , Ayesha AppaAyesha Appa San Francisco, CA More articles by this author , Ralph WangRalph Wang San Francisco, CA More articles by this author , Thomas ChiThomas Chi San Francisco, CA More articles by this author , Joe MillerJoe Miller San Francisco, CA More articles by this author , Jersey NeilsonJersey Neilson San Francisco, CA More articles by this author , Rebecca Smith-BindmanRebecca Smith-Bindman San Francisco, CA More articles by this author , and Marshall StollerMarshall Stoller San Francisco, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2166AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Medical expulsion therapy (MET) with alpha-adrenergic blockade (AB) is an established treatment option for the management of ureteral stones. Multiple studies have noted low utilization of MET in the Emergency Department (ED), however specific reasons for this phenomenon remain largely unknown. Given that AB agents are most typically associated with male urologic conditions such as benign prostatic hyperplasia (BPH), we hypothesized that the underutilization of MET would be most pronounced in women as AB medications are typically used for men with BPH. METHODS Retrospective chart review of patients with an ED diagnosis of urinary stone disease between 2006-2012 was undertaken to identify patient variables related to presentation, history, management, and disposition. We excluded patients with incomplete medical records or a known diagnosis of stone disease within the previous month. RESULTS Between 2006-2012, 729 patients presented to an ED with acute renal colic and were diagnosed with urinary stone disease. 92.9% (677) of all patients were discharged from the ED. Amongst discharged patients, 60.3% (408) were prescribed AB (commonly tamsulosin). 5.5% (40) were discharged with steroids for MET, with 90% (36) of these patients also receiving AB. 36.9% (269) of patients were discharged without any MET. Of those discharged without MET, 34.4% (84 patients) had CT or ultrasound imaging evidence of a ureteral stone. 38% (277) of all patients were female. When considering gender, 48.8% of women (120) were discharged without MET compared to 39.2% (177) of men (p < 0.05). Variables predictive of discharge without MET included female gender (OR 1.8, 95% CI 1.3-2.5, p < 0.05) and clinical diagnosis without use of imaging studies (OR 1.95, 95% CI 1.25-3.06, p < 0.05). Neither age nor a history of stone disease were significantly associated with likelihood of discharge with MET. CONCLUSIONS MET was utilized in only 60% of patients diagnosed with an acute urinary stone in a tertiary care ED, despite a significant portion of patients demonstrating the presence of ureteral stone(s) on imaging. Women were nearly half as likely to receive MET compared to men. We propose that this may be due to providers' perception that AB agents are drugs for male urologic conditions such as BPH. Increased awareness of the underutilization of MET, particularly in women, may help to promote its appropriate use amongst emergency department physicians and other allied health care providers. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e925-e926 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Herman Bagga San Francisco, CA More articles by this author Ayesha Appa San Francisco, CA More articles by this author Ralph Wang San Francisco, CA More articles by this author Thomas Chi San Francisco, CA More articles by this author Joe Miller San Francisco, CA More articles by this author Jersey Neilson San Francisco, CA More articles by this author Rebecca Smith-Bindman San Francisco, CA More articles by this author Marshall Stoller San Francisco, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...