Thank you for your comments and input. We agree that pediatric urolithiasis is an
important topic, and that MET is often underutilized in this population. Based on
the known benefits and potential to avoid surgery, the authors feel it is reasonable
to prescribe MET with a 2-to-4-week trial of stone passage for any unilateral ureteral
stone <10 mm in an appropriately selected patient. Although we did find that use of
MET increased with urology involvement, we respectfully disagree that urology should
be involved for every stone patient seen in the emergency room. We created and shared
a pathway for use in the emergency room to guide stone management in routine patients
without the involvement of urology with the goals of decreasing CT for the initial
diagnosis of stones, increasing outpatient urology and nephrology follow up, and increasing
MET utilization for appropriately selected patients. We are currently re-reviewing
stone management in our ED to assess if use of MET did increase after initiation of
the pathway.
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Article info
Publication history
Published online: February 27, 2023
Accepted:
February 17,
2023
Received:
February 17,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Comment on: Management of pediatric ureterolithiasis in the emergency room: A single institution review and new management pathwayJournal of Pediatric Urology
- PreviewWe have read the paper entitled “Management of pediatric ureterolithiasis in the emergency room: A single institution review and new management pathway”. We congratulate the authors for discussing one of the very important topics in pediatric patients. In the present study, authors found that medical expulsive treatment (MET) is underutilized in pediatric patients with ureteral stones even if MET is very effective with significantly high rate of stone passage. They also mentioned that the reason for this underutilization is related to noninvolvement of pediatric urologists for the management of these patients [1].
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