789 Primary Ureteroscopy in the Emergency Setting: Our Experience from a District General Hospital

Abstract

Abstract Aim The aim of this study is to evaluate how many patients with ureteric stone disease underwent primary ureteroscopy in the emergency setting (eP-URS) and how many of them had their stone retrieved successfully. In those patients in whom eP-URS was not attempted, we assessed if a reason for not doing so was documented. In addition, we analyzed the possible factors influencing the decision to perform a primary ureteroscopy in the emergency setting. Method This is a retrospective observational study of patients presenting to the emergency department of our district general hospital between January and December 2022 with ureteric stone disease requiring emergency surgical intervention in the form of eP-URS or emergency stenting. Results Out of 160 patients presenting with ureteric stone disease, eP-URS was attempted in 35% (n = 56) of patients and in the majority of these patients (64.3%, n = 36), the stone was retrieved successfully. On the other hand, eP-URS was not attempted in 65% patients (n = 104), and a decision for emergency stenting alone was made. A reason for this was clearly documented in 46.1%(n = 48) patients: urosepsis, mucky urine, impacted stone, patient factors, obstructed infected system, while in 53.8% (n = 56) cases no reason was mentioned. In our study, the location of the stone and the presence of consultant in theatre were found to significantly influence the decision to definitive stone surgery (p-value <0.05). Conclusions Despite clear guidance and potential benefits of definitive treatment of ureteric stones, eP-URS is yet to become an everyday practice. Reasons for not attempting eP-URS should be clearly documented.