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 stones

Case 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
BMJ Publishing Group Limited (BMJ Group) 2009. All rights reserved.