WCE 2019: Early Surgical Intervention for Symptomatic Renal and Ureteral Stones Reduces Narcotic Requirement Relative to Medical Expulsive Therapy

Abu Dhabi, United Arab Emirates (UAE) (UroToday.com) This poster and podium presentation outlined a study that investigated whether early surgical intervention in patients with renal and ureteral stones results in less narcotics used for pain compared to a trial of passage with medical expulsive therapy. With the ongoing opioid epidemic, measures to reduce the need of narcotics to control pain are of utmost importance.

Through retrospective chart review, 144 patients were identified. These patients included those who presented with acute renal colic due to a renal or ureteral stone. 77 patients had medical expulsive therapy, 39 had a stent with delayed ureteroscopy, and 28 had ureteroscopy. It was found that about 60% of patients who had medical expulsive therapy required narcotics, versus about 25% of stent patients and 35% of ureteroscopy patients. After the results of this study, the standard of practice at the University of Louisville School of Medicine tolerated no narcotics on discharge except for pain refractory to non-narcotic analgesics.

While many factors are considered when deciding between procedural intervention versus medical management of stones, a narcotic requirement may be a particularly important consideration. Early intervention may reduce the need for narcotics, as shown by this study. Discussion was generated on this topic, as there are many variables that affect prescribing narcotics, such as hospital policies regarding discharging with opioids, and management of patients in the emergency department.

Presented by: Crystal Valadon, Medical Student, Institute of Urology, University of Louisville School of Medicine

Written by: Rajiv Karani, Department of Urology, University of California, Irvine, Medical Writer for UroToday.com, at the 37th World Congress of Endourology (WCE) – October 29th-November 2nd, Abu Dhabi, United Arab Emirates