Monthly Archives: June 2015

EM ONE – June 2015 Still Up All Night – Urology Dogma Challenge Especiale!

Kidney Stone Dogma Challenge Here is the June Late Night Lit Review. There have been several good, potentially practice changing, articles on the management of kidney stones in the last year. I decided to do a deep dive on the … Continue reading

Posted in Monthly THUMBNAIL

1. US for Kidney Stones is Safe and Effective

Practice Change: In patients I suspect of having renal colic, an US will be my first imagining study.   I can always get a CT later if I’m not satisfied with the workup. I may talk to the patients about possible … Continue reading

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2. A Normal Renal Ultrasound IS helpful

Take Home:  Sometimes a negative study is harder to explain to patients than positive studies. These two studies give me a chance to say “Great! Your chance of passing this kidney stone on your own is almost 100%” if I get … Continue reading

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3. Tamsulosin (Flomax) does NOT help pass kidney stones

Practice Change: I will no longer prescribe Flomax for kidney stones.  Medically expulsive therapy of stones appears ineffective.  Our urologists seem to like these medications, and I think we should have a discussion with them about their use. Tamsulosin (Flomax) and … Continue reading

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4. Best Pain Medications in Renal Colic?

Take Home: For patients with renal colic, I will use both an NSAID and opiate up front for pain control.  This study has some problems with dosing, but overall supports a practice that makes intuitive sense. Systematic review of the relative efficacy of non-steroidal … Continue reading

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5. Lidocaine for Renal Colic Pain Control

Take Home: Lidocaine IV seems like a reasonable, “non-opiate” alternative therapy for patients with reasons to not want to provide opiates.  (high opiate tolerance, pregnancy (category B), or suspected abuse). It is just one study, but an interesting alternative I will use. … Continue reading

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6. Do IV Fluids Make Stones Pass?

Take Home: It doesn’t appear that the small amount of available evidence supports this practice. If the expected effect was huge, I’d expect to see some hint of it in these small studies.  I’ll still treat dehydration from persistent vomiting … Continue reading

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