Kidney stones

[PAGuy77]

I work in the ER and we see a lot of Kidney stone Pt.s with acute attacks. My attending is hell-bent on giving and D/Cing home on toradol, as he says it helps dilate the ureters. Also, he advocates CT stone studies in all these patients, even with histroy of stones, to check for things like hydro and blockage. I figured I ask the experts on the subject and see your thoughts to management of these patients. I've heard conflicting arguements about Flomax in these pts as well. Any thoughts?

Thanks

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[cpants]

I work in the ER and we see a lot of Kidney stone Pt.s with acute attacks. My attending is hell-bent on giving and D/Cing home on toradol, as he says it helps dilate the ureters. Also, he advocates CT stone studies in all these patients, even with histroy of stones, to check for things like hydro and blockage. I figured I ask the experts on the subject and see your thoughts to management of these patients. I've heard conflicting arguements about Flomax in these pts as well. Any thoughts?

Thanks

Toradol does not dilate the ureters. It does provide excellent analgesia during renal colic, better than opioids. Sending home on PO toradol is not typical. I'm not sure we can even get that around here. Usually we send them on percocet and flomax. Flomax has been shown to dilate the distal ureter and increase rates of stone passage, admittedly in some poor quality studies. It is extremely well tolerated, so low risk, high reward. Most urologists I know use it for a trial of passage.

As far as CT goes, it really depends on the patient. If they got scanned within the past few months, probably not necessary. If they haven't been scanned in a few years, probably necessary to characterize stone burden and location for surgical planning. Whether or not you get a CT or ultrasound the patient should probably have a plain KUB. If (as most stones are) it is visible on KUB, this allows us to confirm passage with a repeat xray.