/Background: Urolithiasis is an increasingly common condition seen in children with
an annual incidence of 2-3% in children under 18, and up to 10% in adolescents. Treatment
of stones varies including observation, IV hydration, pain management, medical expulsive
therapy (MET), or surgery. Though well-studied and often used in adults, MET, (alpha-adrenergic
antagonists to facilitate passage of ureteral stones), is not routinely prescribed
in pediatric patients.
The goals of this study were to review a quaternary children’s hospital’s emergency
room frequency of MET utilization for ureterolithiasis as well as evaluate the clinical
outcomes of children who were prescribed MET compared to those treated with pain control
A retrospective review was performed of children 2 months to 18 years with ureterolithiasis
who presented to a quaternary children’s hospital ED from 2011-2017. The primary outcome
was the frequency of MET prescribed. Secondary outcomes included the following comparisons
in patients who received MET and analgesics with those who received analgesics alone:
hospital admission rate, length of hospitalization, emergency room re-presentation
rate, surgical intervention, spontaneous stone passage, urology consultation, how
the urology consult affected MET utilization, referral to outpatient urology and nephrology
clinics, and CT utilization in the ED. Comparisons were performed utilizing Fischer’s
exact and t-tests.
139 patients were included with a mean age of 14 years (SD 4.14), 42% male. There
was no difference between age, gender, stone size, return to the ED, serum creatinine,
or length of hospitalization (if admitted) between patients who were and were not
placed on MET. The rate of stone passage was significantly higher for those placed
on MET (45%) versus not (20%), (p= 0.0022). Urology was consulted for 93% of the cases
where children were prescribed MET, compared with only 52% of cases where MET was
not prescribed (p = <0.0001).
In our experience MET was significantly underutilized in patients where urology was
not involved. This is similar to a study by Itano et al which found urology consultation
in the ED significantly increased use of tamsulosin for ureterolithiasis in adults.
Children with ureterolithiasis placed on MET had a significantly higher rate of stone
passage compared to children managed by pain control alone.
Given the benefits of MET to increase the rate of spontaneous stone passage it may
be considered first line therapy for treatment of children with ureterolithiasis.