AUA 2009 - Stone Disease: Evaluation & Medical Management - Medical Expulsive Therapy (MET) for Ureteral Calculi in the Real World: Targeted Education Increases the Use of MET and Improves Patient Outcomes - Session Highlights

CHICAGO, IL, USA ( - Medical expulsive therapy has been shown in controlled trials to improve outcomes for patients with ureteral stones but “real-world” utilization and effectiveness have not been examined. Dr. Christopher Brede et al. from Ann Arbor, MI assessed education of Emergency Department (ED) physicians on the used of MET and analyzed the impact on patient outcomes and cost.

In 2006 University of Michigan ED physicians were educated about MET via Grand Rounds, journal clubs, email notification and department guidelines. Clinical and cost data for ureteral calculi for members of the health maintenance organization operated by the University were collected for ED patients in 2003, 2005 and 2007.

Of 237 patients with ureteral calculi, 166 had data available for analysis, 97 (58%) were prescribed MET and 53 (32%) filled the MET prescription. Prescription of MET increased over time without clear impact of the educational intervention. There was an increased use of alpha-blockers over calcium-channel blockers or no MET therapy in the last year, suggesting that the educational intervention may have played a role in altering provider behavior.

Bivariate analysis showed the frequency of adverse outcomes (repeat ED visits, hospital admission or surgery) over 90 days was lower in the MET group than in the control group (53% versus 38%). MET was associated with lower mean cost per patient ($2,372 versus $1,805). After adjusting for stone size and location, patients receiving MET had lower odds of an adverse event (p=0.05) and decreased costs (p=0.08).

They concluded that targeted educational intervention could increase use of preferred MET in the ED and that MET reduced the incidence of adverse events by 29% and total cost of ureteral stones by 24%.

This abstract was selected as the Best Poster of the MP48 session.

Presented by Christopher M. Brede, MD, et al. at the Annual Meeting of the American Urological Association (AUA) - April 25 - 30, 2009 - McCormick Place Convention Center - Chicago, Illinois, USA.

Written by Jennifer L. Young, MD, a Contributing Editor with UroToday.

The opinions expressed in this article are those of the Contributing Medical Editor and do not necessarily reflect the viewpoints of the American Urological Association. Full AUA Conference Coverage