Children's Hospital and Medical Center, Omaha, NE, USA.

Urolithiasis is an increasingly common condition seen in children with an annual incidence of 2-3 in children under 18 and up to 10 in adolescents Treatment of stones varies including observation IV hydration pain management medical expulsive therapy MET or surgery Though well-studied and often used in adults MET alpha-adrenergic antagonists to facilitate passage of ureteral stones is not routinely prescribed in pediatric patients The goals of this study were to review a quaternary children s hospital s emergency room frequency of MET utilization for ureterolithiasis as well as evaluate the clinical outcomes of children who were prescribed MET compared to those treated with pain control alone A retrospective review was performed of children 2 months to 18 years with ureterolithiasis who presented to a quaternary children s hospital ED from 2011 to 2017 The primary outcome was the frequency of MET prescribed Secondary outcomes included the following comparisons in patients who received MET and analgesics with those who received analgesics alone hospital admission rate length of hospitalization emergency room re-presentation rate surgical intervention spontaneous stone passage urology consultation how the urology consult affected MET utilization referral to outpatient urology and nephrology clinics and CT utilization in the ED Comparisons were performed utilizing Fischer s exact and t-tests 139 patients were included with a mean age of 14 years SD 4 14 42 male There was no difference between age gender stone size return to the ED serum creatinine or length of hospitalization if admitted between patients who were and were not placed on MET The rate of stone passage was significantly higher for those placed on MET 45 versus not 20 p 0 0022 Urology was consulted for 93 of the cases where children were prescribed MET compared with only 52 of cases where MET was not prescribed p 0 0001 In our experience MET was significantly underutilized in patients where urology was not involved This is similar to a study by Itano et al which found urology consultation in the ED significantly increased use of tamsulosin for ureterolithiasis in adults Children with ureterolithiasis placed on MET had a significantly higher rate of stone passage compared to children managed by pain control alone Given the benefits of MET to increase the rate of spontaneous stone passage it may be considered first line therapy for treatment of children with ureterolithiasis Copyright 2022 Journal of Pediatric Urology Company Published by Elsevier Ltd All rights reserved

Children's Hospital and Medical Center, Omaha, NE, USA.

About this institution

Publications Show all

Management of pediatric ureterolithiasis in the emergency room: A single institution review and new management pathway.