Beyond medical expulsive therapy

evolution to supported stone passage for ureteric stones

Andrew J. Portis, Jennifer L. Portis, Michael S Borofsky, Suzanne M. Neises

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: To evaluate the impact of removing tamsulosin from standardized ureteric stone clinical protocols on rate of stone surgery. Participants and Methods: We conducted a single-centre, comparison of all patients with unilateral, <1 cm ureteric stones presenting to a stone clinic after discharge from the emergency department during consecutive years. In the initial year, patients were initially offered medical expulsive therapy (MET) with tamsulosin. In the subsequent year, the protocol was modified to focus on symptom control without tamsulosin; this was termed ‘supported stone passage’ (SSP). The primary outcome was rate of stone surgery within 90 days of the initial clinic encounter. Results: Among 723 patients (360 MET, 363 SSP), the rate of attempted stone passage increased from 65% to 74%, between the initial and the subsequent year (P < 0.016). Tamsulosin prescription in patients to attempting stone passage decreased from 84% to 13% (P < 0.001). In patients attempting stone passage, the rate of stone surgery was 26% in the METand 19% in the SSP group (P = 0.066). The overall surgery rate decreased from 51% in the MET group to 40% in the SSP group (P = 0.003). Multivariable analysis, controlling for age, sex and stone burden, did not demonstrate a difference in either rate of attempting to pass stones or in rate of failure of passage according to care protocol. We were unable to demonstrate an independent effect of tamsulosin on failure of passage. Overall, surgical intervention was less likely in the SSP phase than in the MET phase, with an odds ratio of 0.64 (confidence interval) 0.44–0.91; P = 0.013). Conclusions: Removing tamsulosin from clinical protocols did not impair stone passage in patients attempting to pass stones.

Original languageEnglish (US)
Pages (from-to)661-668
Number of pages8
JournalBJU International
Volume123
Issue number4
DOIs
StatePublished - Apr 1 2019

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tamsulosin
Clinical Protocols
Therapeutics
Group Psychotherapy
Prescriptions
Hospital Emergency Service
Odds Ratio
Confidence Intervals

Keywords

  • medical expulsive therapy
  • tamsulosin
  • ureteric stones
  • ureteroscopy

PubMed: MeSH publication types

  • Journal Article

Cite this

Beyond medical expulsive therapy : evolution to supported stone passage for ureteric stones. / Portis, Andrew J.; Portis, Jennifer L.; Borofsky, Michael S; Neises, Suzanne M.

In: BJU International, Vol. 123, No. 4, 01.04.2019, p. 661-668.

Research output: Contribution to journalArticle

Portis, Andrew J. ; Portis, Jennifer L. ; Borofsky, Michael S ; Neises, Suzanne M. / Beyond medical expulsive therapy : evolution to supported stone passage for ureteric stones. In: BJU International. 2019 ; Vol. 123, No. 4. pp. 661-668.
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abstract = "Objective: To evaluate the impact of removing tamsulosin from standardized ureteric stone clinical protocols on rate of stone surgery. Participants and Methods: We conducted a single-centre, comparison of all patients with unilateral, <1 cm ureteric stones presenting to a stone clinic after discharge from the emergency department during consecutive years. In the initial year, patients were initially offered medical expulsive therapy (MET) with tamsulosin. In the subsequent year, the protocol was modified to focus on symptom control without tamsulosin; this was termed ‘supported stone passage’ (SSP). The primary outcome was rate of stone surgery within 90 days of the initial clinic encounter. Results: Among 723 patients (360 MET, 363 SSP), the rate of attempted stone passage increased from 65{\%} to 74{\%}, between the initial and the subsequent year (P < 0.016). Tamsulosin prescription in patients to attempting stone passage decreased from 84{\%} to 13{\%} (P < 0.001). In patients attempting stone passage, the rate of stone surgery was 26{\%} in the METand 19{\%} in the SSP group (P = 0.066). The overall surgery rate decreased from 51{\%} in the MET group to 40{\%} in the SSP group (P = 0.003). Multivariable analysis, controlling for age, sex and stone burden, did not demonstrate a difference in either rate of attempting to pass stones or in rate of failure of passage according to care protocol. We were unable to demonstrate an independent effect of tamsulosin on failure of passage. Overall, surgical intervention was less likely in the SSP phase than in the MET phase, with an odds ratio of 0.64 (confidence interval) 0.44–0.91; P = 0.013). Conclusions: Removing tamsulosin from clinical protocols did not impair stone passage in patients attempting to pass stones.",
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AB - Objective: To evaluate the impact of removing tamsulosin from standardized ureteric stone clinical protocols on rate of stone surgery. Participants and Methods: We conducted a single-centre, comparison of all patients with unilateral, <1 cm ureteric stones presenting to a stone clinic after discharge from the emergency department during consecutive years. In the initial year, patients were initially offered medical expulsive therapy (MET) with tamsulosin. In the subsequent year, the protocol was modified to focus on symptom control without tamsulosin; this was termed ‘supported stone passage’ (SSP). The primary outcome was rate of stone surgery within 90 days of the initial clinic encounter. Results: Among 723 patients (360 MET, 363 SSP), the rate of attempted stone passage increased from 65% to 74%, between the initial and the subsequent year (P < 0.016). Tamsulosin prescription in patients to attempting stone passage decreased from 84% to 13% (P < 0.001). In patients attempting stone passage, the rate of stone surgery was 26% in the METand 19% in the SSP group (P = 0.066). The overall surgery rate decreased from 51% in the MET group to 40% in the SSP group (P = 0.003). Multivariable analysis, controlling for age, sex and stone burden, did not demonstrate a difference in either rate of attempting to pass stones or in rate of failure of passage according to care protocol. We were unable to demonstrate an independent effect of tamsulosin on failure of passage. Overall, surgical intervention was less likely in the SSP phase than in the MET phase, with an odds ratio of 0.64 (confidence interval) 0.44–0.91; P = 0.013). Conclusions: Removing tamsulosin from clinical protocols did not impair stone passage in patients attempting to pass stones.

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