Understanding the Time-Course of Nephrolithiasis Management

Purpose: The growing incidence of acute nephrolithiasis has increased the burden on healthcare. We sought to assess the time-course of acute stone disease treatment from symptom onset to spontaneous passage or definitive treatment to better characterize the current state of management and identify areas for improvement. Methods: We performed a retrospective review of patients treated for acute nephrolithiasis from August 2016 until February 2017. Patients were included if they had symptomatic renal or ureteral stones, evaluation by urology, and documented resolution by spontaneous passage or surgery. Primary outcome was the time from initial presentation at the Emergency Department (ED) to procedure or passage. Secondary outcomes included time to outpatient evaluation by urology and delays to procedure scheduling greater than 14 days. Results: 61 patients (41% female) met selection criteria. Median time from initial presentation to procedure or stone passage was 45 or 26 days, respectively. Median time from ED to clinic visit was 12.5 days. Time from clinic visit to procedure or spontaneous passage was 29 or 16 days, respectively. 38 patients (62%) had documented causes for delay in treatment. Of this cohort, 22 (58%) were due to provider availability issues, 8 (21%) had contraindications to surgery, and 8 (21%) had patient-related delays.

Conclusion: Prolonged time to treatment of acute nephrolithiasis occurred in 30 (49%) of the cohort due to provider availability and patientspecific delays. Developing initiatives to expedite management through improved patient education and operating room availability may help reduce healthcare costs and patient discomfort.

Keywords: Kidney stones; Time-course; Urolithiasis; Ureteroscopy; SWL; PCNL

Abbreviations: ACU: acute care urology, AUA: American Urological Association, ED: Emergency Department, EHR: Electronic health record, IRB: Institutional Review Board, MET: Medical expulsive therapy, NHANES: National Health and Nutrition Examination Survey, UC: Urgent Care