Login to Access Video or Poster Abstract: MP50-01
Sources of Funding: none

Introduction

Ureteroscopy causes discomfort for patients postoperatively. This manifests as flank or bladder pain, and most postoperative medication regiments include a centrally acting opioid medication. Data on the most appropriate pain medication after ureteroscopy is limited. There is increasing scrutiny on narcotic prescriptions in America to reduce abuse, and narcotic use is associated with many undesirable and dangerous side effects. For this reason, we sought to evaluate whether different strengths of postoperative opioid medications impacted the rate of patient return to the emergency room (ER), unplanned clinic visits for pain, or overall 3 month readmission rate.

Methods

After IRB approval, retrospective chart review was performed for patients who underwent outpatient ureteroscopy for purposes of renal or ureteral stone removal from February 1, 2014 through March 31, 2016. The pain medication that was prescribed, and the patient’s postoperative course was evaluated for the first 3 months after surgery. Both ER visits, and clinic calls/visits were analyzed. Clinic and ER contacts were excluded if they did not pertain to urinary or flank pain. Pain medications were classified into 4 categories based on their DEA drug schedule: Schedule II, III, IV, and over the counter (OTC) medications. A Chi-square test was used for analysis.

Results

475 patients were identified with complete charts and follow up. The results of our data are summarized in the table below. 199 patients received schedule II medicines, 165 received schedule III medications, 72 received schedule IV medications, and 39 received OTC medications. The rates of return to ER, clinic, or re-admission within 3 months were not significantly different from each other.

Conclusions

The strength of pain medication prescribed after ureteroscopy appears to have no bearing on whether a patient will contact the urologist due to pain. Specifically, medications such as hydrocodone and oxycodone, which have a higher abuse potential, do not prevent out of control pain in the postoperative period better than safer alternatives. Re-admission rate within 3 months was not impacted by postoperative pain medication either. This information should be considered to improve prescription narcotic stewardship in the world of increasing oversight, overdose, and abuse.

Funding

none