MP63-01 NEGATIVE URETEROSCOPY FOR URETERIC STONES

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy VI (MP63)1 Apr 2020MP63-01 NEGATIVE URETEROSCOPY FOR URETERIC STONES Masood Moghul*, Omar Elhalawaty, Luis Fernando Arenas Da Silva, Ahmed Almushatat, Prasad Patki, and Zubeir Ali Masood Moghul*Masood Moghul* More articles by this author , Omar ElhalawatyOmar Elhalawaty More articles by this author , Luis Fernando Arenas Da SilvaLuis Fernando Arenas Da Silva More articles by this author , Ahmed AlmushatatAhmed Almushatat More articles by this author , Prasad PatkiPrasad Patki More articles by this author , and Zubeir AliZubeir Ali More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000938.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteroscopic surgery for stone disease has seen major advancements with the advent of modern ureteroscopes, offering better imaging quality and less trauma. Ureteroscopic surgery is accepted to be safe but crucially it is not complication free. Ureteric perforation or avulsion is the most serious complications, not withstanding anaesthetic risks. There is no consensus regarding repeating a CTKUB to confirm stone passage prior to ureteroscopy. The balance of patient risks between performing repeated CT scans and offering surgery varies between individual patients. There is also a cost-benefit analysis to be considered with the average cost of a ureteroscopy around £2000 ($2500) compared with around £200 ($250) for a non-contrast CT scan. METHODS: In our institution we audited our ureteroscopies for ureteric stones over a 6-month period (January 2018-June 2018). Negative ureteroscopies were defined as those where the stone had passed. RESULTS: During the 6-month period 158 ureteroscopies were performed in our department for stone disease, 95 for ureteric stones. 13 (13.7%) were negative. The mean stone size was 9.51mm (+/- 4.65mm), ranging from 2-11mm. Stone positioning on pre-operative CT is shown in figure 1. 43 ureteroscopies were performed for stones 7mm and smaller, of which 12 were negative (27.9%). Therefore 12/13 negative ureteroscopies were for ureteric stones <= 7mm. Of the 13 negative ureteroscopies, 3 patients had a repeat CT prior to surgery. 11 of the patients had no JJ stent prior to surgery, whilst 2 patients did (neither of these had a repeat CT scan). CONCLUSIONS: The debate between repeating CT scan/imaging prior to ureteroscopy for ureteric stones will be on-going with multiple patient and logistical factors needed to be taken into consideration. At our institution, following on from this audit, we plan to repeat a CTKUB on the morning of surgery for all patients planned for primary ureteroscopy for stones < 7mm. We shall continue to list patients directly for ureteroscopy for stones >7mm and remove them from the list if there is patient reported stone passage. These patients will be seen in a stone clinic for follow up. We envisage this will reduce the rate of negative ureteroscopy whilst also facilitating a streamlined and quicker time to surgery for our patients. Source of Funding: n/a © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e954-e954 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masood Moghul* More articles by this author Omar Elhalawaty More articles by this author Luis Fernando Arenas Da Silva More articles by this author Ahmed Almushatat More articles by this author Prasad Patki More articles by this author Zubeir Ali More articles by this author Expand All Advertisement PDF downloadLoading ...