PD10-11 INTRAOPERATIVE CONTRAST ENHANCED ULTRASOUND TO REDUCE UNNECESSARY URETERAL STENT PLACEMENT AFTER URETEROSCOPY

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology I (PD10)1 Sep 2021PD10-11 INTRAOPERATIVE CONTRAST ENHANCED ULTRASOUND TO REDUCE UNNECESSARY URETERAL STENT PLACEMENT AFTER URETEROSCOPY Justin Ahn, David Bayne, Fadl Hamouche, Marshall Stoller, and Thomas Chi Justin AhnJustin Ahn More articles by this author , David BayneDavid Bayne More articles by this author , Fadl HamoucheFadl Hamouche More articles by this author , Marshall StollerMarshall Stoller More articles by this author , and Thomas ChiThomas Chi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001978.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral stents are a significant source of morbidity. The decision to place one at the time of retrograde intrarenal surgery (RIRS) is often subjective. A reliable tool is needed to guide urologists and avoid unnecessary stent placement. Contrast enhanced ultrasound (CEUS) is a safe, readily adaptable technology where a microbubble contrast agent is instilled into the upper urinary tract (Figure 1). We propose an intraoperative retrograde CEUS test during RIRS to help predict post-operative ureteral drainage and the need for ureteral stent placement. METHODS: For this pilot feasibility study, we performed CEUS in patients undergoing RIRS for nephrolithiasis. After stone treatment, the renal collecting system was decompressed, then 1 ml of CEUS contrast and a 2 ml flush was instilled per ureteral catheter. For the flush, iodinated contrast was substituted for saline to permit comparison with fluoroscopic drainage. After catheter removal and 2 minutes for ureteral rest, the bladder was cycled with irrigation and then scanned with CEUS and fluoroscopy for passage of either contrast agent (Figure 1). Ureteral stent placement was determined based on preexisting standard of care. Post-operative unplanned encounters (PUE) were tracked. RESULTS: 41 renal units underwent CEUS during RIRS (Figure 2). Stent omission was successful with no PUE in 91% with CEUS drainage. Compared to those who had a stent placed based on no CEUS drainage, those who did not have a stent based on drainage had a significantly lower incidence of complications (9% vs 53%, p=0.006) Fluoroscopic drainage was discordant with CEUS drainage in 12 renal units. In all cases of discordance, drainage was seen on CEUS but not on fluoroscopy. CONCLUSIONS: CEUS is a novel means to objectively assess upper tract drainage at the time of RIRS. Our results suggest that retrograde CEUS could predict successful stent omission and may be more sensitive for predicting drainage than fluoroscopy due to low contrast volumes. Source of Funding: AUA Care Foundation © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e131-e131 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin Ahn More articles by this author David Bayne More articles by this author Fadl Hamouche More articles by this author Marshall Stoller More articles by this author Thomas Chi More articles by this author Expand All Advertisement Loading ...