Login to Access Video or Poster Abstract: MP75-20
Sources of Funding: MSI Foundation, Edmonton, Alberta

Introduction

Renal colic is a common condition affecting up to 10% of the population causing significant morbidity. Research has shown that an unsuccessful trial of medical expulsive therapy has no detrimental impact on the patients (Portis et al., Urology 2015). Therefore, we wish to evaluate a large cohort of renal colic patients in a high intervention setting to determine the effect of stone location and treatment on patient outcomes.

Methods

This multicenter administrative database study retrospectively reviewed the all Calgary patients with an ED diagnosis of renal colic between Jan 1, 2014 and Dec 31, 2014. Demographics were captured from the regional ED database, tests and treatments from the order entry database, and ED revisits, admissions and interventions from the discharge abstract database. Events were collated from all regional hospitals (4 sites).

Results

3104 renal colic visits were studied at 4 hospitals, including 921 (29.7%) with an index surgical intervention and 2183 (70.3%) managed medically. 1850 (59.6%) had imaging confirmed ureteral stones with 752 (40.6%) of these patients receiving surgery at an index visit. While proximally located ureteral stones were more likely to receive surgery at the index visit (OR = 2.177, 95% CI 1.80-2.64; P< 0.001), distally located stones were still frequently operated on with 34% of distal stones receiving surgery. Distal stones that are treated surgically at the index visit are more likely to re-visit the emergency department (OR = 2.011, 95% CI 1.535-2.635; p<0.001) and be admitted (OR = 3.103, 95% CI 2.130-4.520; p<0.001). There was no significant difference in patients returning for further surgery within 60 days of the index visit between these two groups (p=0.232).

Conclusions

Patients that present with acute renal colic and have an imaging confirmed distal ureteral stones are commonly operated on at the sites analyzed. Distal ureteral stones that were managed surgically were more likely than those that received conservative management to re-visit the emergency department and be admitted. These findings suggest that conservatively managing patients with distally located stones does not have a negative effect on these patients. This retrospective study does not consider complicating factors that may have influenced the treatment of these patients. Surgical intervention remains an appropriate treatment for distal ureteral stones depending on the individual contexts of patient cases.

Funding

MSI Foundation, Edmonton, Alberta