Acupuncture as adjunctive therapy for acute renal colic caused by urinary calculi: study protocol for a randomized controlled trial

Background Acute renal colic caused by urinary calculi (ARCUC) has a considerable impact on the quality of life. Acupuncture might be a potential treatment option. However, the evidence is limited. We will conduct this trial to evaluate the efficacy and safety of acupuncture as adjunctive treatment to diclofenac for ARCUC. Methods/design A total of 80 eligible patients who are diagnosed with urinary stone renal colic will be randomly allocated to the acupuncture group or the sham acupuncture group. Each patient will receive 1 session of acupuncture or sham acupuncture. The primary outcome will be the response rate of patients achieving a reduction of > 50% on visual analog score (VAS) from baseline to 10 min after treatment. Secondary outcomes will include the VAS, remedial analgesia, re-visit and admission rate, blinding assessment, credibility and expectancy, and adverse event. All patients who receive randomization will be included in the intent-to-treat analysis. Discussion The finding of this trial will provide evidence on the efficacy and safety of acupuncture for the treatment of ARCUC. The results of this study will be published in peer-reviewed journals. Trial registration ClinicalTrials.gov ChiCTR 1900025202. Registered on August 16, 2019.

84 Optimising The Assessment and Management of Acute Renal Colic in Secondary Care

Aim The latest guidance in acute renal colic states that patients should have serum calcium and urate (stone bloods) measured during inpatient admission. The guidance also states that follow-up imaging should be in the form of computed tomography (CT)-, ultrasound (USS)-, or X-ray- kidney, ureters and bladder (KUB). X-ray intravenous urogram (IVU) is now considered obsolete as it can result in over-exposing patients to radiation. Aims of this 2-cycle QIP were twofold; Method Data was extracted from electronic patient records on whether or not they had stone bloods measured during admission and also what follow-up imaging was requested. In the first cycle baseline data was extracted. A stone proforma was then created, incorporating the latest guidelines. In the second cycle the impact of the stone proforma was assessed. Results The study included 119 patients. After introducing the stone proforma we were successful in improving the rate of stone bloods being measured, increasing from 13% to 53%. We were also successful in reducing the rate of performing X-ray IVU, decreasing from 25% to 14% of patients. Conclusions This QIP demonstrates that management of acute renal colic can be optimised using a stone proforma and move current practice towards best practice. This is supported by the ‘Getting it Right First Time’ (GIRFT) Urology report 2018. The third cycle is currently underway, and we hope to see further improved outcomes.

327 Relative Benefits of Extracorporeal Shockwave Lithotripsy (ESWL) Compared to Observation in Acute Renal Colic

Aim NICE guidance recommends patients with renal colic be offered surgical treatment, including extracorporeal shockwave lithotripsy (ESWL), within 48 hours if pain is uncontrolled or stones unlikely to pass. We compared outcomes for ureteric stone passage after ESWL with those of observation to ascertain the relative benefits of ESWL. Method We collected data on stone location, size, and number of ESWL treatments required prospectively over 18 months. Stone passage was confirmed radiologically. Data were compared with MIMIC, a multi-centre collaborative study examining spontaneous stone passage after observation alone. Results 166 patients had ESWL for ureteric stones. Median size was 6.5mm (IQR 5.0-8.0mm). 57.2% (N = 95) were proximal stones. Smaller stones required fewer treatments (P = 0.003). Patients with a ureteric stone <5mm required median 1.0 ESWL treatments (IQR 1.0-2.0). Ureteric stones 5-7mm had median 1.0 treatments (IQR 1.0-2.0) and stones >7mm median 2.0 treatments (IQR 1.0-2.0). Compared to MIMIC, patients with ESWL for stones <5mm were 11% more likely to achieve stone clearance (100.0% vs 89.0%, P = 0.001). ESWL for 5-7mm stones had 28.1% greater clearance compared to observation (77.1% vs. 49.0%, P < 0.001) and ESWL for stones >7mm 21% greater likelihood of clearance (50.0% vs. 29.0%, P < 0.001). Proximal ureteric stones were 16.4% more likely to pass with ESWL than observation (68.4% vs 52%, P = 0.02). Distal stones showed similar passage with ESWL (77.5%) and observation (83.0%), P = 0.43. Conclusions Proximal ureteric stones and those >5mm stones benefit most from ESWL. Results aid identification of patients whose stones are less likely to pass and warrant urgent review to consider ESWL.