Objectives
To evaluate if trial of passage (TOP) or initial surgical intervention resulted in
less narcotic analgesia utilization in patients with acute renal colic due to stone
disease.
Methods
We retrospectively evaluated 135 patients with acute renal colic due to nephroureterolithiasis
managed by a single surgeon. Patients were standardly offered TOP or surgical intervention
with ureteroscopy (URS). A subset of patients were stented with delayed URS due to
presence of infection, pain, or a nonaccommodating ureter. Our standard practice is
narcotic-free URS, prescribing a stent cocktail including non-steroidal anti-inflammatories.
We compared rates of narcotic prescription over the entire treatment course for patients
electing TOP vs surgery (primary or delayed URS). We secondarily analyzed rates of
surgical intervention among initial TOP.
Results
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. Thirty-nine (56.5%) TOP patients underwent
URS at a median time of 18 days (IQR 6-31 days) from diagnosis. More TOP patients
required a narcotic prescription (60.9% vs 35.9% vs 33.3%, respectively; P = .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.
Conclusion
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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Centers for Disease Control and Prevention. Vital signs: opioid prescribing: where you live matters, 2017. Available at: https://www.cdc.gov/vitalsigns/opioids/index.html (Accessed November 12, 2019)
- Clinical indications associated with opioid initiation for pain management in Ontario, Canada: a population-based cohort study.Pain. 2018; 159: 1562-1568
Centers for Disease Control and Prevention. Vital signs: opioid overdoses treated in emergency departments, 2018. Available at: https://www.cdc.gov/vitalsigns/opioids/index.html (Accessed August 8, 2019)
Centers for Disease Control and Prevention. Policy impact: prescription painkiller overdoses, 2011. Available at:https://www.cdc.gov/drugoverdose/pdf/PolicyImpact-PrescriptionPainkillerOD-a.pdf (Accessed November 12, 2019)
- Prevalence of kidney stones in the USA: the national health and nutrition evaluation survey.J Clin Urol. 2018; 12: 296-302
- Emergency department visits in the United States for upper urinary tract stones: trends in hospitalization and charges.J Urol. 2014; 191: 90-96
- Kidney stones and risk of narcotic use.J Urol. 2019; 202: 114-118
- Surgical management of stones: American Urological Association/Endourological Society guideline, PART II.J Urol. 2016; 196: 1161-1169
- Tamsulosin as a medical expulsive therapy for ureteral stones: a systematic review and meta-analysis of randomized controlled trials.J Urol. 2019; 201: 950-955
- Medical expulsive therapy is underused for the management of renal colic in the emergency setting.J Urol. 2016; 195: 987-991
- New persistent opioid use after outpatient ureteroscopy for upper tract stone treatment.Urology. 2019; 134: 103-108
- Initial experience with narcotic-free ureteroscopy: a feasibility analysis.J Endourol. 2018; 32: 907-911
- A retrospective review demonstrating the feasibility of discharging patients without opioids after ureteroscopy and ureteral stent placement.J Endourol. 2018; 32: 1044-1049
American Urological Association: AUA position statement: opioid use. Available at: https://www.auanet.org/guidelines/opioid-use. (Accessed April 12, 2020)
- Recommendations for opioid prescribing after endourological and minimally invasive urological surgery: an expert panel consensus.J Urol. 2020; 203: 151-158
- Unsuccessful medical expulsive therapy: a cost to waiting?.Urology. 2016; 87: 25-32
- Understanding the barriers to the dissemination of medical expulsive therapy.J Urol. 2010; 184: 2368-2372
- Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial.Lancet. 2015; 386: 341-349
- Distal ureteric stones and tamsulosin: a double-blind, placebocontrolled, randomized, multicenter trial.Ann Emerg Med. 2016; 67: 86-95
- Effect of tamsulosin on passage of symptomatic ureteral stones: a randomized clinical trial.JAMA Intern Med. 2018; 178: 1051-1057
- A systematic review and meta-analysis comparing the efficacy of nonsteroidal anti-inflammatory drugs, opioids, and paracetamol in the treatment of acute renal colic.Eur Urol. 2018; 73: 583-595
- Delivering safe and effective analgesia for management of renal colic in the emergency department: a double-blind, multigroup, randomised controlled trial.Lancet. 2016; 387: 1999-2007
- Emergency room follow-up trends in urolithiasis: single-center report.Urology. 2009; 73: 1195-1197
- Clinical predictors of 30-Day emergency department revisits for patients with ureteral stones.J Urol. 2016; 196: 1467-1470
- Payer type, race/ethnicity, and the timing of surgical management of urinary stone disease.J Endourol. 2019; 33: 152-158
- Opiate exposure and predictors of increased opiate use after ureteroscopy.J Endourol. 2019; 33: 480-485
- Opiate exposure and predictors of increased opiate use after ureteroscopy.J Endourol. 2019; 33: 480-485
- Development of dependence following treatment with opioid analgesics for pain relief: a systematic review.Addiction. 2012; 108: 688-698
Article info
Publication history
Published online: September 29, 2020
Accepted:
August 3,
2020
Received:
January 9,
2020
Footnotes
Financial Disclosures: Amy Krambeck is a paid consultant for Boston Scientific and Lumenis. She is the on the data safety and monitoring board for Sonomotion. Tim Large is a paid consultant for Boston Scientific and Lumenis.
Funding: none
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
