1063 Prioritising Primary Ureteroscopy: Getting It Right First Time in Patients with Obstructing Urolithiasis by Using a New Treatment Pathway

Abstract

Abstract Aim Obstructing urolithiasis should be cleared on first attempt, minimising the need for multiple treatments and associated morbidity. Achieving this primary ureteroscopy (P-URS) standard is paramount in the post-pandemic era, where elective waiting lists cannot afford to accommodate ‘stent and wait’ patients. This project aims to evaluate the efficiency of our modified stone treatment pathway which focusses on P-URS. Method We conducted 3 audit cycles in the years 2018, 2020 and 2022 including all patients listed for emergency stone surgery. Extracted data included age, sex, stone number, location and size, and presence of sepsis. Between 2018 and 2022, all Urologists were encouraged to follow a modified stone treatment pathway with an emphasis on P-URS. Results P-URS and attempted URS increased from 7.4% to 62.7%. The average waiting time for subsequent treatment in those who did not have primary/attempted URS was 135 days (23- 412) in 2020 and 95 days (23 -152) in 2022. Sepsis as justification for not attempting P-URS accounted for 19% of cases in 2018 and 21% in 2022. Stent insertion led to subsequent URS in > 95% of cases, ESWL was rarely used. Spontaneous stone after stenting occurred in only 3% of patients. There was no significant difference in WCC, CRP, age, sex or stone distribution between the cycles. No P-URS patients re-presented with complications. Conclusions Limited spontaneous stone passage means P-URS is necessary. Furthermore, it is safe and reduces long waiting times for almost certain subsequent surgery, benefiting both patients and the NHS.