MP15-05 PERCUTANEOUS NEPHROSTOMY, URETERAL STENT OR PRIMARY URETEROSCOPY WITH STONE REMOVAL FOR THE TREATMENT OF HYDRONEPHROSIS SECONDARY TO URETERIC CALCULI: A PROSPECTIVE EVALUATION OF THE IMPACT ON COMPLICATIONS, STONE MANAGEMENT AND HEALTH-RELATED QUALITY OF LIFE

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy III (MP15)1 Apr 2020MP15-05 PERCUTANEOUS NEPHROSTOMY, URETERAL STENT OR PRIMARY URETEROSCOPY WITH STONE REMOVAL FOR THE TREATMENT OF HYDRONEPHROSIS SECONDARY TO URETERIC CALCULI: A PROSPECTIVE EVALUATION OF THE IMPACT ON COMPLICATIONS, STONE MANAGEMENT AND HEALTH-RELATED QUALITY OF LIFE Ricardo Matos Rodrigues*, Bárbara Silva, Nuno Morais, José Pedro Pereira, Sara Anacleto, Pedro Passos, Torres João, Emanuel Dias, Estêvão Lima, and Paulo Mota Ricardo Matos Rodrigues*Ricardo Matos Rodrigues* More articles by this author , Bárbara SilvaBárbara Silva More articles by this author , Nuno MoraisNuno Morais More articles by this author , José Pedro PereiraJosé Pedro Pereira More articles by this author , Sara AnacletoSara Anacleto More articles by this author , Pedro PassosPedro Passos More articles by this author , Torres JoãoTorres João More articles by this author , Emanuel DiasEmanuel Dias More articles by this author , Estêvão LimaEstêvão Lima More articles by this author , and Paulo MotaPaulo Mota More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000840.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral calculi can be associated with urinary drainage blockage requiring urgent treatment, usually with urinary diversion with percutaneous nephrostomy or retrograde ureteral stent, but primary ureteroscopy with stone removal can be an option. Currently no strong evidence exists to support the superiority of one method over the others. This study proposes to compare these three approaches regarding stone management efficacy, complication rate and its effect on patient's quality of life (QoL). METHODS: A prospective trial was carried out and 94 patients were selected with hydronephrosis secondary to ureteral stones requiring urgent urinary treatment. The patients were divided into three groups according to treatment technique: percutaneous nephrostomy (PCN), retrograde ureteral stent (RUS) or primary ureteroscopy with stone removal (pURS). The stone management efficacy, complications and QoL were evaluated (EQ VAS). RESULTS: A PCN group (n=21), a RUS group (n=53) and a pURS group (n=20) were set. Stone size was higher in RUS (median=9mm) than PCN (median=8mm) and pURS (median=7mm). All pURS successfully removed the stone and the spontaneous stone passage (SSP) after multivariable analysis was higher for PCN than RUS (OR=2,31). A decrease between pre- and post-intervention QoL was found with RUS (p<.001), but not found with PCN (p = .092) and an increase was found with pURS (p=.011). Patients in pURS group experienced less haematuria (p<.001), dysuria (p<.001), urgency (p<.001) (table 1.1), and less need of antibiotics use (p=.005), than RUS and PCN (table 1.2). CONCLUSIONS: pURS shows better chance of higher stone management efficacy than PCN and RUS, moreover PCN was associated with higher rate of spontaneous stone passage than RUS. The QoL improve for pURS patients and decrease for RUS patients. pURS was associated with less symptoms and complications than PCN and RUS, regarding RUS had the higher level of patients with symptoms and complication rate. The pURS appears to be a safe and optimal solution for treatment of patients with ureteral calculi with urinary drainage blockage requiring active treatment. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e205-e206 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ricardo Matos Rodrigues* More articles by this author Bárbara Silva More articles by this author Nuno Morais More articles by this author José Pedro Pereira More articles by this author Sara Anacleto More articles by this author Pedro Passos More articles by this author Torres João More articles by this author Emanuel Dias More articles by this author Estêvão Lima More articles by this author Paulo Mota More articles by this author Expand All Advertisement PDF downloadLoading ...