PD34-02 NATURAL HISTORY OF RESIDUAL FRAGMENTS AFTER AGGRESSIVE URETEROSCOPY AND FRAGMENT RETRIEVAL

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy V (PD34)1 Apr 2020PD34-02 NATURAL HISTORY OF RESIDUAL FRAGMENTS AFTER AGGRESSIVE URETEROSCOPY AND FRAGMENT RETRIEVAL Ryan L. Steinberg*, Brett A. Johnson, Igor Sorokin, Alaina Garbens, Vishnuvardhan Ganesan, Joseph Crivelli, Abdulhadi Akhtar, Jodi Antonelli, and Margaret Pearle Ryan L. Steinberg*Ryan L. Steinberg* More articles by this author , Brett A. JohnsonBrett A. Johnson More articles by this author , Igor SorokinIgor Sorokin More articles by this author , Alaina GarbensAlaina Garbens More articles by this author , Vishnuvardhan GanesanVishnuvardhan Ganesan More articles by this author , Joseph CrivelliJoseph Crivelli More articles by this author , Abdulhadi AkhtarAbdulhadi Akhtar More articles by this author , Jodi AntonelliJodi Antonelli More articles by this author , and Margaret PearleMargaret Pearle More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000905.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Follow-up of patients with residual fragments (RFs) after ureteroscopy (URS) for upper tract stones has shown that the occurrence of stone-related events is common. Short-term follow up of a cohort with RFs detected by CT after URS revealed that 41% of patients experienced a stone-related event (SE) at a mean follow-up of 16 months. We have continued to follow these patients with RFs to determine intermediate outcomes. METHODS: Between December 2015 and February 2017, 167 patients (209 renal units, RUs) underwent URS for renal and ureteral calculi and were imaged with CT at 6-8 weeks post-operatively. Patients were evaluated at subsequent office visits with imaging studies and/or contacted by phone to determine the occurrence of stone events attributable to their RFs. A stone event was defined as spontaneous stone passage, symptoms requiring emergency department (ED) visit, surgical intervention, or stone growth. Patients with RFs of any size were included for analysis. Stone-event free survival (SEFS) was determined by the Kaplan Meier analysis and risk factors for an event were identified by logistic regression. RESULTS: A total of 73 patients (87 RUs) had RFs after URS with a median follow-up of 29 months (IQR 22-34). The mean number of RFs per patient on post-operative CT was 2.1 ± 1.5 and mean largest fragment size was 3.7 ± 2.0 mm. SE occurred in 47% of RUs (41/87). Unplanned ED or clinic visits occurred in 13%, a secondary stone surgery was required in 17%, and 17% of patients experienced spontaneous stone passage. The median time to SE was 20 months (IQR 7-26). Neither size (p=0.11) nor location (p=0.816) of the residual fragment predicted a stone event. Bilateral procedures were associated with an increased risk of a stone event (OR 3.2, CI 1.4 – 7.8, p=0.01), while increasing age (OR 0.3, CI 0.1 – 0.8, p=0.01) and male gender (OR 0.9, CI 0.91– 0.98, p<0.01) were protective on multivariable analysis. By Kaplan-Meier analysis, SEFS was 74% at 24 months year and 58% at 30 months post-operatively (Figure). CONCLUSIONS: With longer follow up, nearly half of patients left with RFs after URS will experience a SE, rates comparable to those following SWL. Better patient selection for URS and new ways to enhance stone free rates after URS are essential to improve outcomes. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e711-e712 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan L. Steinberg* More articles by this author Brett A. Johnson More articles by this author Igor Sorokin More articles by this author Alaina Garbens More articles by this author Vishnuvardhan Ganesan More articles by this author Joseph Crivelli More articles by this author Abdulhadi Akhtar More articles by this author Jodi Antonelli More articles by this author Margaret Pearle More articles by this author Expand All Advertisement PDF downloadLoading ...