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Liang G Qu,1,2,* Garson Chan,1– 3,* Johan Gani1,2,4 1Department of Urology, Austin Health, Heidelberg, Victoria, Australia; 2Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia; 3Department of Surgery, Division of Urology, University of Saskatchewan, Saskatoon, SK, Canada; 4Department of Urology, Western Health, Footscray, Victoria, Australia*These authors contributed equally to this workCorrespondence: Liang G Qu, Department of Urology, Austin Health, Heidelberg, Victoria, Australia, Tel +61 3 9496 5000, Email dr.liang.qu@gmail.comPurpose: Recommendations for alpha-blockers have shifted in the conservative management of ureteral stones. It is unknown whether real-life practices regarding alpha-blocker prescriptions reflect updates in evidence. This study aimed to characterise alpha-blocker prescriptions for conservatively managed ureteral stones and relate this to recent literature.Methods: This was a retrospective audit, 01/01/2014 to 01/01/2019, of emergency acute renal colic presentations. Patients were included if they had a confirmed ureteral stone and were conservatively managed. The rates of alpha-blocker prescriptions were analysed using interrupted time-series analyses. May 2015 was selected as the cut-point to analyse before and after trend lines. Results were stratified by stone size and location. Tamsulosin and prazosin prescriptions were also compared.Results: This study included 2163 presentations: 70.4% were stones ≤ 5 mm and 61.4% were proximal stones. Altogether, 24.7% of presentations were prescribed alpha-blockers. There was a fall in alpha-blocker prescription rates from before to after May 2015, regardless of stone size or location (p < 0.001). Since May 2015, however, there was a monthly rate increase of 0.5% for patients with stones > 5mm.Conclusion: This study demonstrated a significant shift in rates of alpha-blocker prescriptions, possibly related to the influence of updates in available high-quality evidence.Keywords: adrenergic alpha-antagonists, emergency medicine, renal colic, ureteric calculus |
