Delayed Stone Treatment Increases Morbidity

Unplanned clinical visits 15 times more likely among patients treated more than 45 days after diagnosis.
Unplanned clinical visits 15 times more likely among patients treated more than 45 days after diagnosis.

NEW ORLEANS—Delaying treatment for urinary stones is associated with increased patient morbidity and more frequent use of imaging studies and antibiotics, researchers reported at the American Urological Association annual meeting.

Nicholas Kavoussi, MD, and colleagues at the University of Texas Southwestern Medical Center in Dallas studied 795 patients who underwent surgical treatment for stones. The median time from stone diagnosis to surgery was 79 days. Of these patients, 199 underwent initial placement of a stent (125 patients) or percutaneous nephrostomy (PCN, 74 patients); 52 of these 74 patients required 1 or more tube changes prior to treatment. The researchers identified 714 unplanned encounters that were required for 432 patients (54.3%), including 11.2% who required hospitalization.

Patients treated more than 45 days after diagnosis were more likely to have unplanned clinic and emergency department (ED) visits and more likely to have imaging studies performed and to have a positive urine culture requiring antibiotic treatment. In adjusted analyses, compared with patients treated within 45 days of diagnosis, those treated more than 45 days after diagnosis had a significant 15.2 times increased odds of an unplanned clinic visit, 3.6 times increased odds of an ED visit, 5.7 times increased odds of having an imaging study performed, and 3.4 times increased odds of requiring antibiotics. Among patients who underwent PCN, those treated after 45 days had a significant 24.3 times increased odds of requiring a nephrostomy tube change.

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