How to use Clinical Evidence to get the most up-to-date information, quickly, to

aid your decision making

A case presentation using the CE review on kidney stones

A typical history of ureteric stonesCase history

• 37-year-old man• Self-employed builder• After a few twinges over past 2 months, presents with 2 hours of excruciating pain in left groin• KUB appears normal in A+E, but blood ++ on urine dip• Referred to urology• IVU showed two small calculi, 4 mm and 5 mm, sited in left mid-ureter, with no signs of dilatation or hydronephrosis

Questions that might arise…

What is the best conservative management?• Analgesia and fluids are the obvious answers, but…

– How much fluid?– Some people use hyoscine as an adjunct to other analgesics —

is this a good idea?– Is there anything else that could be done?– How strong is the evidence supporting our usual practice?

Removing symptomatic

ureteric stones

Management of acute renal colic

alpha-blockers categorised as

‘Likely to be beneficial’

fluids categorised as ‘Unknown effectiveness’

antispasmodics categorised as ‘Unlikely to be beneficial’

moderate-quality evidence for using alpha-blockers

full details about the RCTs

(tamsulosin was the most

commonly tested)

no good RCT evidence to

support high-volume iv fluids

Changing management

• Consider adding an alpha-blocker (possibly tamsulosin) to speed up stone explusion

• Avoid anti-spasmodics• Stick with regular iv fluid replacement

Summary• Clinical Evidence can be used to make sure your

practice is up to date– Answers clinical questions– Keeps you informed of new treatments– Demonstrates when existing treatments are not supported by

good evidence

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