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Improving care to decrease stone recurrence and opioid use
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DOI：10.1038/s41585-019-0275-2.png)
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Abstract
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In 2019, quality improvement has been a central theme throughout leading articles on nephrolithiasis. Real-world outcomes were published on the natural history of stones and residual fragments, patient compliance with medical therapy and treatment-related opioid use. In-depth review of these topics will enhance provider-patient counselling and shape future paradigms in stone disease. Key advances Compared with basketing, dusting of kidney stones sized 5-20 mm decreased operating times by 30 minutes without differences in stone-free rates, complications or additional procedures at 6 weeks1. Within 3 months after ureteroscopy, patients with residual stone fragments >= 3 mm had at least a fivefold increased risk for repeat future surgical intervention, particularly those without obesity2. In a prospective analysis, 67% of first-time symptomatic stone formers had stone recurrence at 5 years; in patients with concurrent asymptomatic stones, 51% had stone passage at 5 years but only 52% of these reported symptoms3. In a tertiary-care population, long-term adherence rates to stone prevention medications were 42% for alkali citrate and 52% for hydrochlorothiazide5. In a population of uric acid stone formers with obesity, preventive drug adherence rates were 53% and adherent patients had smaller stone recurrences and fewer stone surgeries than those who did not adhere to their regimen6. In a nationally representative population, history of nephrolithiasis was associated with a 27% increase in current narcotic use, and 6-9% of previously opioid-naive patients prescribed an opioid for pain management continued use at 3-6 months after first prescription7-9.
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