EARLY SURGICAL INTERVENTION FOR SYMPTOMATIC RENAL AND URETERAL STONES IS ASSOCIATED WITH REDUCED NARCOTIC REQUIREMENT RELATIVE TO TRIAL OF PASSAGE.

To evaluate if trial of passage or initial surgical intervention resulted in less narcotic analgesia utilization in patients with acute renal colic due to stone disease.

We retrospectively evaluated 135 patients with acute renal colic due to nephroureterolithiasis managed by a single surgeon. Patients were standardly offered trial of passage (TOP) or surgical intervention with ureteroscopy (URS). A subset of patients were stented with delayed URS due to presence of infection, pain, or a non-accommodating ureter. Our standard practice is narcotic-free ureteroscopy, prescribing a stent cocktail including non-steroidal anti-inflammatories. We compared rates of narcotic prescription over the entire treatment course for patients electing TOP versus surgery (primary or delayed URS). We secondarily analyzed rates of surgical intervention among initial TOP.

We included 135 patients, with 69 (51.1%) TOP as initial treatment, 39 (28.9%) stent with delayed URS, and 27 (20.0%) primary URS. 39 (56.5%) TOP patients underwent URS at a median time of 18 days (IQR 6-31days) from diagnosis. More TOP patients required a narcotic prescription (60.9% vs 35.9% vs 33.3%, respectively; p=0.010) compared to patients undergoing initial stent or URS. However, when an opioid prescription was provided, the total morphine milligram equivalents prescribed among each group was not statistically significant.

Patients electing initial treatment with TOP for renal colic due to stone disease were more likely to require narcotic prescriptions than patients electing initial surgical intervention.

Urology. 2020 Sep 29 [Epub ahead of print]

Lauren Abrams, Amy Krambeck, Crystal Valadon, Charles Nottingham, Joshua Heiman, Tim Large

Indiana University School of Medicine, Department of Urology, Indianapolis, IN. Electronic address: ., Indiana University School of Medicine, Department of Urology, Indianapolis, IN.