The momentum of kidney stone patient “expulsion” from the emergency department has never been greater. Big stone? No problem. Obstruction? No problem. Infection? That’s the problem. Some of these patients may require admission.
A recent interesting malpractice claims trend has prompted a reassessment of outpatient management of nephrolithiasis. Females with an active ureteral stone with obstruction and, most important, possible urinary tract infection (UTI) have returned with pyelonephritis and sepsis, suffering horrific outcomes. Urinary symptoms, other than those associated with acute ureterolithiasis, are often absent in these patients.
Although few recommendations deserve inclusion of an “always” or a “never,” this trend at least deserves some consideration in our approach to certain cases.