Current practices in the management of patients with ureteral calculi in the emergency room of a university hospital.
OBJECTIVE
Urinary lithiasis is a common disease. The aim of the present study is to assess the knowledge regarding the diagnosis, treatment and recommendations given to patients with ureteral colic by professionals of an academic hospital.


METHODS
Sixty-five physicians were interviewed about previous experience with guidelines regarding ureteral colic and how they manage patients with ureteral colic in regards to diagnosis, treatment and the information provided to the patients.


RESULTS
Thirty-six percent of the interviewed physicians were surgeons, and 64% were clinicians. Forty-one percent of the physicians reported experience with ureterolithiasis guidelines. Seventy-two percent indicated that they use noncontrast CT scans for the diagnosis of lithiasis. All of the respondents prescribe hydration, primarily for the improvement of stone elimination (39.3%). The average number of drugs used was 3.5. The combination of nonsteroidal anti-inflammatory drugs and opioids was reported by 54% of the physicians (i.e., 59% of surgeons and 25.6% of clinicians used this combination of drugs) (p = 0.014). Only 21.3% prescribe alpha blockers.


CONCLUSIONS
Reported experience with guidelines had little impact on several habitual practices. For example, only 21.3% of the respondents indicated that they prescribed alpha blockers; however, alpha blockers may increase stone elimination by up to 54%. Furthermore, although a meta-analysis demonstrated that hydration had no effect on the transit time of the stone or on the pain, the majority of the physicians reported that they prescribed more than 500 ml of fluid. Dipyrone, hyoscine, nonsteroidal anti-inflammatory drugs, and opioids were identified as the most frequently prescribed drug combination. The information regarding the time for the passage of urinary stones was inconsistent. The development of continuing education programs regarding ureteral colic in the emergency room is necessary.
Hospital Universitário, Faculdade de Medicina, Universidade de São Paulo, Brasil. oliver.claros@bol.com.br
Oliver Rojas
OR
Claros
Carlos Hirokatsu Watanabe
CH
Silva
Horacio
H
Consolmagno
Americo Toshiaki
AT
Sakai
Rodrigo
R
Freddy
Oscar Eduardo Hidetoshi
OE
Fugita
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D004636:Emergency Service, Hospital; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006785:Hospitals, University; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011859:Radiography; D056844:Renal Colic / Q000000981:diagnostic imaging / Q000628:therapy*; D014514:Ureteral Calculi / Q000000981:diagnostic imaging / Q000628:therapy*
D000317:Adrenergic alpha-Antagonists; D000700:Analgesics