Alpha-Blocker Prescribing Trends for Ureteral Stones: A Single-Centre Study
Liang G Qu1,2, Garson Chan1,2,3, Johan Gani1,2,4
1Department of Urology, Austin Health, Heidelberg, Victoria, Australia.
Research and Reports in Urology
|September 5, 2022
Summary
Alpha-blocker prescriptions for ureteral stones decreased after May 2015, reflecting updated evidence. However, prescriptions for larger stones (>5mm) showed a slight monthly increase post-May 2015.
Area of Science:
- Urology
- Pharmacology
- Evidence-based Medicine
Background:
- Clinical practice guidelines for alpha-blocker use in ureteral stone management have evolved.
- It remains unclear if real-world prescribing patterns align with recent evidence-based recommendations.
Purpose of the Study:
- To analyze trends in alpha-blocker prescriptions for patients with conservatively managed ureteral stones.
- To assess the correlation between prescription patterns and updated medical literature.
Main Methods:
- A retrospective audit of 2163 emergency renal colic presentations between 2014 and 2019.
- Interrupted time-series analysis was used to evaluate alpha-blocker prescription rates before and after May 2015, stratified by stone characteristics.
Main Results:
- Overall alpha-blocker prescription rates declined significantly after May 2015 (p < 0.001).
- A modest monthly increase of 0.5% in prescriptions was observed for stones >5mm after May 2015.
- Prescription rates for tamsulosin and prazosin were compared.
Conclusions:
- A notable shift in alpha-blocker prescribing practices for ureteral stones was observed.
- This change likely reflects the impact of updated high-quality evidence on clinical decision-making.
Related Concept Videos
01:30Urinary Tract Calculi III: Medical Management
19
The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
19
01:25Urinary Tract Calculi VI: Surgical Management
21
Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
21
01:28Urinary Tract Calculi V: Nursing Management
24
AssessmentSubjective Data: Obtain a detailed health history, including any recent or chronic urinary tract infections, periods of immobilization, previous episodes of renal calculi, and medical conditions such as gout, benign prostatic hyperplasia, or hyperparathyroidism. Review the medication history for drugs that may influence stone formation, including allopurinol, analgesics, loop diuretics, or thiazide diuretics. Document the use of long-term indwelling catheters and any past surgical...
24
01:27Urinary Tract Calculi IV: Nutrition Therapy and Prevention
23
Management of renal calculi focuses on effective strategies like tailored nutrition and hydration therapy. Adjusting diet and fluid intake reduces stone formation and recurrence, making these interventions simple yet powerful in kidney stone prevention and management.Understanding Kidney StonesKidney stones form when calcium, oxalate, uric acid, and cystine concentrate and crystallize in urine. Factors contributing to their formation include genetic predisposition, certain medical conditions,...
23
01:26Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations
35
Renal calculi, commonly termed kidney stones, are crystalline solid masses that form in the kidneys but can occur at any point within the urinary system, encompassing the kidneys, ureters, bladder, and urethra.The pathophysiology of renal stones involves several key factors: supersaturation of the urine with stone-forming constituents, changes in urine pH, a decrease in urine volume, and the presence of substances that promote or inhibit stone formation.Supersaturation of Urine: This is the...
35
01:28Urinary Tract Calculi I: Introduction
34
Renal calculi, or kidney stones, are solid deposits of minerals and salts formed inside the kidneys. In medical terminology, "calculus" refers to the stone itself, while "lithiasis" describes the process of stone formation. Depending on their location within the urinary system, these stones may be classified as either urolithiasis, when situated within the urinary tract, or nephrolithiasis, when located within the kidneys. Each term signifies the specific impact of the stone.Predisposition...
34