Barriers in Managing Acute Ureteric Colic Clinical Review and Commentary

With the global prevalence of urolithiasis increasing, the presentation of acute ureteric colic to emergency departments (ED) poses a significant burden on healthcare systems globally. Management strategies for ureteric colic encompass medical expulsion therapy and various interventional modalities aimed at urinary diversion or definitive stone management. By examining potential or established barriers to managing acute ureteric colic, we can minimise strain on healthcare providers while maintaining patient outcomes. This review aims to assess barriers to the management of acute ureteric colic through a comprehensive overview of the current literature. Acute ureteric colic barriers will be assessed throughout a patient’s disease progression, borrowing a conceptual framework used to assess barriers in cancer care management. Barriers will be discussed in the context of patient-centred access to healthcare, clinical evaluation and diagnosis, and management. Numerous barriers to healthcare have been identified throughout the natural course of acute ureteric colic, both specific and non-specific. Patient-centred barriers typically arise during the initial onset of acute ureteric colic. Originating from patient awareness and access to healthcare, they include barriers founded on race inequalities, cultural beliefs, geographic location, transportation, and the concept of a universal standard of healthcare. Having accessed healthcare, barriers in the management of acute ureteric colic next occur during the clinical evaluation and diagnosis period. These are typically associated with clinical assessment or diagnostic imaging delays, including underutilisation of ultrasound, nurse-led pathways for faster clinical reviews, and general ED delays. The final period during acute ureteric colic management correlates to clinical management. The inherent unpredictable course of ureteral stones leads to poor prognostication and failed initial management modalities. Additionally, this period deals with periprocedural delays and preventative health. Barriers to the management of acute ureteric colic arise during a patient's journey through accessing healthcare. Reviewing barriers allow further research into areas requiring modification to expedite care and improve outcomes.