Medical expulsive therapy underused for ureteral stones

(HealthDay)—For patients with ureteral stones, medical expulsive therapy remains underused, according to a study published in the April issue of The Journal of Urology.

Christopher Loftus, from the Lerner College of Medicine in Cleveland, and colleagues conducted a retrospective analysis of patients seen in the emergency department to examine the penetrance of medical expulsive therapy guideline recommendations. Data were included for 2,105 emergency department visits associated with an International Classification of Diseases, Ninth Revision diagnosis of urolithiasis, during which computerized tomography abdomen/pelvis scans were performed.

The researchers found that 48.8 percent of patients had ureteral stones, including 50 percent in whom medical expulsive therapy was prescribed. No significant difference was seen for patients who did and did not receive medical expulsive therapy. No difference was seen in the rate of urological procedures within 12 weeks of the initial emergency department visit or in the rate of return to the emergency department in patients who received medical expulsive therapy. A shorter time to spontaneous expulsion was seen for patients treated with medical expulsive therapy (7.1 versus 12.8 days; P = 0.048).

"Half of the patients who met criteria for medical expulsive therapy in this study did not receive the standard of care," the authors write. "These results highlight the need for personnel at emergency departments to better standardize care for patients with ureteral stones."

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