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INTRODUCTION AND OBJECTIVE:Patients who sustain traumatic injuries are at risk for developing post-traumatic stress and mental health disease. Due to the nature of the injuries, trauma that affects...

INTRODUCTION AND OBJECTIVE:Young adults with spina bifida are at extraordinary risk for poor health outcomes and have high rates of costly healthcare utilization. However, reasons for this high-cos...

INTRODUCTION AND OBJECTIVES:AUA guidelines state that high-grade renal injuries with urinary extravasation (UE) may be managed conservatively and followed with routine repeat imaging. We sought to ...

INTRODUCTION AND OBJECTIVES:While the field of genitourinary reconstruction and trauma (GURT) is growing, the majority of urologists do not manage acute GU trauma patients in their practices. Our o...

INTRODUCTION AND OBJECTIVES:The grading of segmental vascular injuries (SVI) following blunt renal trauma represent a controversial topic with the 2011 revised injury staging classification categor...

Patients with ureteral stones frequently present to the emergency department for an initial evaluation with pain and/or nausea. However, a subset of these patients subsequently return to the emergency department for additional visits. We sought to identify clinical predictors of emergency department revisits.We reviewed emergency department visits at our institution with an ICD-9 diagnosis of urolithiasis and an associated computerized tomography scan between 2010 and 2013. Computerized tomography studies were independently reviewed to confirm stone size and location, and degree of hydronephrosis. The primary outcome was a second emergency department visit within 30 days of the initial visit for reasons related to the stone. Patient characteristics and stone parameters at presentation were recorded. Univariable and multivariable analyses were done to identify factors associated with emergency department revisits.We reviewed the records of 1,510 patients 18 years old or older who presented to the emergency department with a diagnosis of ureteral stones confirmed by computerized tomography. Of the patients 164 (11%) revisited the emergency department within 30 days. On multivariable analysis the presence of a proximal ureteral stone, age less than 30 years and the need for intravenous narcotics in the emergency department remained independently associated with an emergency department revisit.Younger patients, those with proximal stones and those requiring intravenous narcotics for pain control are more likely to return to the emergency department. Consideration should be given for early followup or intervention for these patients to prevent costly emergency department returns.

Although the 2007 AUA (American Urological Association) guidelines established it as first line therapy for ureteral stones less than 10 mm, widespread adoption of medical expulsive therapy has been low. We determined the current penetrance of medical expulsive therapy guideline recommendations and the efficacy of medical expulsive therapy in reducing the requirement for urological procedures after emergency department visits for ureteral stones.In a retrospective analysis of patients seen in the emergency department we included 2,105 emergency department visits associated with an ICD-9 diagnosis of urolithiasis in which computerized tomography abdomen/pelvis scan was performed. Outcomes were reviewed for spontaneous passage or required urological procedure.Ureteral stones were found in 48.8% of patients, including 50.0% in whom medical expulsive therapy was prescribed. There was no significant difference between patients who did and did not receive medical expulsive therapy. Within 12 weeks of the initial emergency department visit there was no difference in the rate of urological procedures performed in those who received medical expulsive therapy or in the rate of return to the emergency department. Patients treated with medical expulsive therapy experienced a shorter time to spontaneous expulsion (7.1 vs 12.8 days, p = 0.048).Medical expulsive therapy for renal colic in the emergency setting remains underused. Half of the patients who met criteria for medical expulsive therapy in this study did not receive the standard of care. Patients treated with medical expulsive therapy achieved spontaneous passage more quickly but there was no difference in the requirement for a urological procedure. These results highlight the need for personnel at emergency departments to better standardize care for patients with ureteral stones.