MP01-03 PATIENT CENTERED FACTORS INFLUENCING URETERAL STONE PASSAGE

Abstract

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation I1 Apr 2017MP01-03 PATIENT CENTERED FACTORS INFLUENCING URETERAL STONE PASSAGE Andrew Portis, Jennifer Portis, and Suzanne Neises Andrew PortisAndrew Portis More articles by this author , Jennifer PortisJennifer Portis More articles by this author , and Suzanne NeisesSuzanne Neises More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.078AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients generally prefer to avoid surgery for ureteral stones. The initial management decision is a leap of faith influenced by patient and physician experiences and preferences. We explore the impact of patient centered factors on initial decision making. METHODS As an element of an ongoing quality improvement program, patients presenting to a subspecialty stone clinic after discharge from Emergency Department were identified. Inclusion criteria were unilateral ureteral stone <= 10mm on computed tomography and freedom from infection. Patients completed PROMIS pain intensity and pain interference symptom surveys (PROMIS score of 60 = 1 standard deviation above US population average). Patients participated in a shared decision making process between ureteroscopy and medical expulsive therapy (MET). Patients electing MET were followed for 90 days from initial clinic encounter in standardized fashion. RESULTS Between 6/1/2014 and 5/31/2016, 686 patients met inclusion criteria consisting of 300 with proximal and 386 with distal ureteral stones. MET was elected by 483 (70.4%) patients including 164 (55%) proximal and 319 (82%) distal stone patients. Logistic regression demonstrates that patients with proximal stones, larger stone sizes, and higher PROMIS pain intensity were associated with choosing ureteroscopy (all p<0.001, Figure 1). Amongst patients electing MET, 61 (37.2%) proximal and 45 (14.1%) distal stone patients eventually had ureteroscopic stone clearance. Logistic regression demonstrates patients with proximal and larger stones were more likely to require surgery (all p<0.001, Figure 2). CONCLUSIONS As expected, patients with larger, more proximal stones were less likely to choose and be successful with stone passage. While of prognostic utility, these factors are beyond patient and physician control. However, outpatient symptom control after discharge from Emergency Department could be improved and may be an important opportunity to increase the number of patients attempting stone passage. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1-e2 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Andrew Portis More articles by this author Jennifer Portis More articles by this author Suzanne Neises More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...