PD14-02 EARLY SURGICAL INTERVENTION FOR SYMPTOMATIC RENAL AND URETERAL STONES REDUCES NARCOTIC REQUIREMENT RELATIVE TO MEDICAL EXPULSIVE THERAPY

Abstract

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II (PD14)1 Apr 2020PD14-02 EARLY SURGICAL INTERVENTION FOR SYMPTOMATIC RENAL AND URETERAL STONES REDUCES NARCOTIC REQUIREMENT RELATIVE TO MEDICAL EXPULSIVE THERAPY Crystal Valadon*, Charles Nottingham, Tim Large, and Amy Krambeck Crystal Valadon*Crystal Valadon* More articles by this author , Charles NottinghamCharles Nottingham More articles by this author , Tim LargeTim Large More articles by this author , and Amy KrambeckAmy Krambeck More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000848.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Given the substantial burdens of the current opioid crisis, clinicians are tasked with reducing excessive narcotic analgesia. The purpose of this study was to evaluate if medical expulsive therapy or initial surgical intervention resulted in less narcotic analgesia utilization in patients with acute renal colic due to stone disease. METHODS: We retrospectively evaluated patients at our institution who presented with acute renal colic due to a renal or ureteral stone. We excluded patients who required surgical intervention for acute kidney injury or infection. Patients are standardly offered medical expulsive therapy (MET) or surgical intervention with ureteral stenting or ureteroscopy (URS) at the time of diagnosis. Our standard practice following surgery is to provide no narcotics upon discharge except for pain refractory to non-narcotic analgesics. We compared rates of narcotic prescription over the entire treatment course for patients electing MET versus surgery at initial diagnosis. We secondarily analyzed rates surgical intervention among initial MET patients. RESULTS: We included 144 patients for analysis, with 77 (53.5%) electing MET as initial treatment, 39 (27.1%) stent with delayed URS, and 28 (19.4%) primary URS. Ultimately, 45 (58.4%) MET patients underwent URS at a median time of 18 days (IQR 6.5-33.5 days) from diagnosis. A significantly higher proportion of MET patients required a narcotic prescription (59.7% vs 25.6% vs 35.7%, respectively; p=0.001) compared to patients electing initial stent or URS. CONCLUSIONS: Patients electing initial treatment with MET for renal colic due to stone disease were more likely to require a narcotic prescription than patients electing initial surgical intervention. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e272-e273 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Crystal Valadon* More articles by this author Charles Nottingham More articles by this author Tim Large More articles by this author Amy Krambeck More articles by this author Expand All Advertisement PDF downloadLoading ...