Elective Ureteroscopy Research Articles

252 Analysis of the High Readmission Rate Following Elective Ureteroscopy – the Need for Improved Patient Information on Stent-Related Symptoms

252 Analysis of the High Readmission Rate Following Elective Ureteroscopy – the Need for Improved Patient Information on Stent-Related Symptoms

Vulnerability to Financial Toxicity From Stone Surgery.

Financial toxicity has been described in stone formers; however, little is understood regarding its causes and how it may relate to stone surgery. We therefore aimed to longitudinally describe markers of financial strain in stone formers from the preoperative to postoperative time points. A prospective cohort study was conducted from January 2022 to April 2023. Patients were enrolled in the waiting area prior to undergoing elective ureteroscopy or percutaneous nephrolithotomy. Participants completed The Commonwealth Fund's Biennial Health Insurance Survey at this time point and at 30 days postoperatively. Items were preselected from the survey to capture markers of financial strain due to health care costs. One hundred nine participants were enrolled. White (70%), college-educated (62%), and privately insured (72%) patients comprised the majority of participants. Despite these traditionally protective sociodemographic features, 42% of patients reported some marker of financial strain at the preoperative time point. Patients with Medicaid reported even higher financial stress (67%). Furthermore, 46% of patients did not know their deductible amount. Response rate was low at 30 days postoperatively (35%) but suggested some patients were experiencing new financial strains. This paper shows that a significant proportion of stone patients are already displaying markers of financial strain from health care bills even prior to surgery as well as poor understanding of the costs they may incur. This makes them vulnerable to experiencing financial toxicity postoperatively and emphasizes the importance of understanding all contributing factors when developing future strategies to intervene in financial toxicity.

Success rate and complications of performing elective ureteroscopy in

The aim of this study was to compare the outcomes, success rate, and complications of performing elective ureteroscopy at different times: <1 week from renal colic initiation (early) and more than 1 week from renal colic initiation (late) in patients with ureteral stone larger than 6 mm. This comparative observational study was conducted on 338 consecutive patients. Patients were evaluated in two groups: patients who underwent ureteroscopy in <1 week (A) and patients who underwent ureteroscopy in more than 1 week (B) from renal colic initiation. Helical unenhanced computed tomography was used to assess the size, location, and hardness of stone for all patients. Operation success was defined as complete clearance of stone with no stone residue (stone free) at 2-week postoperative ultrasonography with no need to further interventions. Operation data were collected using medical records, and postoperative complications were investigated at 2 weeks postoperative follow-up visits. Group A included 165 patients and Group B included 173 patients. The overall mean stone size was 8.60 ± 1.12 mm: for Group A 9.13 ± 0.94 mm and for Group B 8.10 ± 1.04 mm (P < 0.001). Stone residues were found in 11 patients: 9 in Group A (5.4%) and 2 in Group B (1.1%) (P = 0.026). Nine patients needed repeated ureteroscopy: 8 (4.8%) in Group A and 1 (0.6%) in Group B (P = 0.015). A double-J stent was used for 85 (51.5%) patients in Group A and 66 (38.2%) patients in Group B (P = 0.016). Major intraoperative complications did not happen in any patients. Fifty-three (32.1%) patients in Group A and 28 (16.2%) patients in Group B suffered from postoperative complications (P = 0.001). Our study revealed that performing elective ureteroscopy with an interval of more than 1 week from the onset of renal colic in combination with medical treatments was associated with less need for double-J stent placement, less need for repeated ureteroscopy, and fewer postoperative complications compared to performing elective ureteroscopy in <1 week from the renal colic onset in nonemergent patients with ureteral stone larger than 6 mm. Although the rate of ureteroscopy failure was higher among the patients who underwent ureteroscopy in <1 week from their renal colic initiation, there was no statistically significant relationship between performing ureteroscopy in <1 week and an increased risk for ureteroscopy failure.

Urgent ureterorenoscopy as a primary treatment for ureteral stone: why not?

To evaluate the feasibility of urgent ureteroscopy (uURS) and elective ureteroscopy (eURS) in the management of patients with renal colic due to ureteral stones. Patients who were operated for ureteral stones between September 2020 and March 2022 were determined retrospectively. The patients who were operated within the first 24 h constituted the uURS group, while the patients who were operated after 24 h were classified as eURS. No limiting factors such as age, gender and concomitant disease were determined as inclusion criteria. Patients with bilateral or multiple ureteral stones, bleeding diathesis, patients requiring emergency nephrostomy or decompression with ureteral JJ stent, and pregnant women were not included. The two groups were compared in terms of stone-free rate, complications, and overall outcomes. According to the inclusion–exclusion criteria, a total of 572 patients were identified, including 142 female and 430 male patients. There were 219 patients in the first group, the uURS arm, and 353 patients in the eURS arm. The mean stone size was 8.1 ± 2.6. The stone-free rate was found to be 87.8% (502) in general, and 92 and 85% for uURS and eURS, respectively. No major intraoperative or postoperative complications were observed in any of the patients. Urgent URS can be performed effectively and safely as the primary treatment in patients with renal colic due to ureteral stones. In this way, the primary treatment of the patient is carried out, as well as the increased workload, additional examination, treatment and related morbidities are prevented.

Preoperative urine culture with contaminants is not associated with increased risk for urinary tract infection after ureteroscopic stone treatment.

We aimed to assess whether the presence of contaminants in the pre-operative urine culture (preop-UC) predicts postoperative urinary tract infection (postop-UTI) in patients undergoing elective ureteroscopy with laser lithotripsy. A retrospective chart review was performed from 01/2019 to 12/2021 examining patients with unilateral stone burden ≤ 2cm who underwent ureteroscopy with laser lithotripsy and had a preop-UC within 3months. Positive, negative, contaminated, and polymicrobial definitions for UCs were established in accordance with current guidelines. Patients with positive and polymicrobial cultures were excluded. Postop-UTI was defined as the presence of urinary symptoms and a positive UC within 30days of the procedure. Multivariable logistic regression models were utilized to evaluate risk factors for contamination in the preop-UC and the risk of postop-UTI. A total of 201 patients met the inclusion-exclusion criteria. Preop-UC was negative in 153 patients and contaminated in 48 patients. Significant contaminant-related factors included female gender and increased BMI. Postop-UTI was diagnosed in 3.2% of patients with negative preop-UCs and 4.2% of patients with contaminants, with no difference between groups (p = 0.67). The regression model determined that the presence of contaminants in preop-UC failed to predict postop-UTI (OR 0.69, p = 0.64). The presence of contaminants in preop-UCs is not associated with an increased risk of postop-UTIs after ureteroscopy. Our study supports that contaminants in the preop-UC can be interpreted as a negative UC in terms of postop-UTI risk stratification. Preoperative antibiotics should not be prescribed for patients undergoing uncomplicated ureteroscopy for stone surgery in the setting of a contaminated preop-UC.

PD28-09 A MULTI-INSTITUTIONAL ANALYSIS OF HUMAN IN VIVO INTRARENAL PRESSURE DURING URETEROSCOPY

You have accessJournal of UrologyCME1 Apr 2023PD28-09 A MULTI-INSTITUTIONAL ANALYSIS OF HUMAN IN VIVO INTRARENAL PRESSURE DURING URETEROSCOPY Stefanie Croghan, Sorcha O'Meara, Eoghan Cunnane, Connor Cunnane, Muheilan Muheilan, Mutaz Elamin, Kenneth Patterson, Steven Anderson, Jody Khan, James Forde, Rustom Manecksha, Fergal O'brien, Michael Walsh, and Niall Davis Stefanie CroghanStefanie Croghan More articles by this author , Sorcha O'MearaSorcha O'Meara More articles by this author , Eoghan CunnaneEoghan Cunnane More articles by this author , Connor CunnaneConnor Cunnane More articles by this author , Muheilan MuheilanMuheilan Muheilan More articles by this author , Mutaz ElaminMutaz Elamin More articles by this author , Kenneth PattersonKenneth Patterson More articles by this author , Steven AndersonSteven Anderson More articles by this author , Jody KhanJody Khan More articles by this author , James FordeJames Forde More articles by this author , Rustom ManeckshaRustom Manecksha More articles by this author , Fergal O'brienFergal O'brien More articles by this author , Michael WalshMichael Walsh More articles by this author , and Niall DavisNiall Davis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003313.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Elevated intrarenal pressure is a proposed risk factor for adverse clinical outcomes in endourology. However, minimal human data exists on baseline or ureteroscopic pressures within the upper urinary tract. We aimed to quantify in vivo intrarenal pressure in a consecutive patient sample undergoing ureteroscopy and assess for correlation between pressure dynamics and clinical outcome. METHODS: A prospective, multi-institutional study was designed with ethical approval. One hundred consenting adult patients undergoing elective ureteroscopy were included. The Comet™ II Pressure Guidewire (Boston Scientific), was placed retrograde within the renal pelvis under fluoroscopy prior to ureteroscopy. Semi-rigid and/or flexible ureteroscopy/renoscopy was performed according to surgeon’s standard practice. The AVVIGOTM (Boston Scientific) System provided live intrarenal pressure recordings, to which the operating surgeon was blinded. Baseline and ureteroscopic intrarenal pressures were recorded. Thirty-day follow up of clinical outcomes was completed and statistical analysis performed. RESULTS: Analysis of 309 unique pressure traces from 100 consecutive patients (56 male; 44 female) was performed. Mean patient age was 57.21±13.73 years. Ureteroscopy was performed for urolithiasis in 94% (n=94) and for other diagnostic indications in 6% (n=6); 26% (n=26) were pre-stented. The mean resting baseline intrarenal pressure (IRP) was 17.47±10.66 mmHg. Semi-rigid ureteroscopy (URS) was performed with a 6.5-7.5Fr ureteroscope in 30% (n=30), with mean IRP 39.55±17.66 mmHg. Flexible ureterorenoscopy (FURS) with a 9.1-10Fr instrument was performed in 93% (n=93). FURS without a ureteral access sheath (UAS) resulted in mean IRP 38.12±16.33 mmHg. FURS using an 11/13Fr UAS resulted in IRPs (mean±SD) of 30.1±20.48mmHg (gravity irrigation); 43.04±24.87mmHg (pressurised irrigation at 100mmHg); 46.53±25.05mmHg (pressurised irrigation at 150mmHg) and 79.74±61.66 (pressurised irrigation at 200mmHg). Readmission with pyrexia occurred in 4% (n=4); mean procedural IRP in this cohort was significantly higher than controls at 120.25±67.88mmHg versus 41.3±26.4mmHg(p<0.001). CONCLUSIONS: Both baseline intra-renal pressures and ureteroscopic pressures exhibit variability. Intraoperative IRP is related to technical variables. High intrarenal pressure values are positively correlated with postoperative pyrexia, however the complication pressure threshold appears to be higher than previously thought. Source of Funding: Boston Scientific (Investigator Sponsored Research product grant). © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e822 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stefanie Croghan More articles by this author Sorcha O'Meara More articles by this author Eoghan Cunnane More articles by this author Connor Cunnane More articles by this author Muheilan Muheilan More articles by this author Mutaz Elamin More articles by this author Kenneth Patterson More articles by this author Steven Anderson More articles by this author Jody Khan More articles by this author James Forde More articles by this author Rustom Manecksha More articles by this author Fergal O'brien More articles by this author Michael Walsh More articles by this author Niall Davis More articles by this author Expand All Advertisement PDF downloadLoading ...

MP10-20 SINGLE DOSE PREOPERATIVE PREGABALIN IN URETEROSCOPY – RESULTS OF A RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologyCME1 Apr 2023MP10-20 SINGLE DOSE PREOPERATIVE PREGABALIN IN URETEROSCOPY – RESULTS OF A RANDOMIZED CONTROLLED TRIAL Geoffrey Rosen, Paige Hargis, Connor Lough, Alp Kahveci, Andrew Moss, Mojgan Golzy, and Katie Murray Geoffrey RosenGeoffrey Rosen More articles by this author , Paige HargisPaige Hargis More articles by this author , Connor LoughConnor Lough More articles by this author , Alp KahveciAlp Kahveci More articles by this author , Andrew MossAndrew Moss More articles by this author , Mojgan GolzyMojgan Golzy More articles by this author , and Katie MurrayKatie Murray More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003225.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Perioperative pregabalin is used as a part of many enhanced recovery after surgery programs. There is mixed evidence regarding its efficacy, with decreased pain, anxiety, and nausea in some settings, and no impact in others. Here, we tested the safety and efficacy of single-dose perioperative pregabalin in our patients undergoing elective ureteroscopy. METHODS: This double-blind trial was IRB approved and registered (MU#2017676, NCT03927781). We randomized patients undergoing ureteroscopy to receive 300mg pregabalin or placebo one hour before surgery. Patients were excluded if they did not have normal renal or cognitive function. They could not have prior history of complex urological conditions and could not be on chronic narcotics. We had patients perform a visual analog pain scale and a Watson clock drawing before medication administration and approximately one hour after surgery. RESULTS: One-hundred eighteen patients were enrolled, randomized, and received medication. The groups differed in median age (control 57 vs 44 years study, p=0.009) with no difference in other baseline characteristics. Preoperative pain scores were similar in both groups (0.5 vs 0.6, for control and study, respectively, Figure 1). Patient reported post operative pain scores were worse in the study group (2 vs 3.7, p=0.004) as was the change in score per individual (0.9 vs 2, p=0.04). On multivariable analysis including age, gender, and study group there was no statistically significant effect of the medication (p=0.1). Change in Watson clock scores were not different based on medication (-0.05 vs -0.15, P=0.98, placebo and pregabalin, respectively), even after accounting for gender and age. CONCLUSIONS: In this single center double-blind randomized controlled trial, we demonstrate that pregabalin does not decrease pain after ureteroscopy when compared to placebo. We also show that there was no negative impact of high dose pregabalin on cognition after the procedure. There is a need to find better adjunctive treatments for pain related to ureteroscopy, but our results suggest that, while safe, single dose perioperative pregabalin may not be efficacious in this setting. Source of Funding: University of Missouri Research Council Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e122 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Geoffrey Rosen More articles by this author Paige Hargis More articles by this author Connor Lough More articles by this author Alp Kahveci More articles by this author Andrew Moss More articles by this author Mojgan Golzy More articles by this author Katie Murray More articles by this author Expand All Advertisement PDF downloadLoading ...

Insomnia and wake up and recovery from anesthesia: a prospective observational study

Purpose: The aim of this study was to investigate whether wake up and recovery from anesthesia is earlier or later in patients with insomnia.&#x0D; Material and Methods: This study included adult patients who were scheduled for elective ureteroscopy under general anesthesia. Using the Jenkins-Sleep Questionnaire (JSQ), the patients were separated into two groups: Insomnia Group and Control Group. Anaesthesia was standardized. After anesthesia induction, 4-6 % desflurane in nitrous oxide/oxygen (60-40%) concentration at flow of 3 L min¯¹ was administered. The parameters recorded were noninvasive arterial blood pressure, heart rate, peripheral oxygen saturation, end-tidal carbon dioxide values, inspiratory and expiratory concentrations of desflurane, anesthesia time, surgery time, time of eye opening, time of transfer to the recovery room. Pain was assessed with a Visual Analogue Scale (VAS) and recovery with the Modified Aldrete Recovery Score (MARS). &#x0D; Results: Evaluation was made of 80 patients, comprising 25 females and, 55 males, grouped as 42 patients in the insomnia group and 38 in the control group. The demographic and hemodynamic data were not significantly different between the groups. The time of eye opening, transfer to the recovery room, VAS and MARS values were similar in both groups. When operation times were classified as ˂ 30 min. and ≥ 30 min, no significant differences were determined between the groups in respect of wake up, recovery and pain parameters.&#x0D; Conclusion: Compared with normal sleepers, patients with insomnia showed no differences in respect of wake up and recovery from anesthesia.

Practice patterns and outcomes of urgent versus elective ureteroscopy in a statewide surgical collaborative.

Urgent indications for nephrolithiasistreatment include obstructionwith intractable pain or renal impairment without untreated infection. Patients and hospitals may benefit from urgent primary ureteroscopy. We aimed to examine variation in urgent ureteroscopy utilization and associated outcomes. Using Reducing Operative Complications from Kidney Stones (ROCKS), we identified all ureteroscopy's between 2016 and 2019. Cases were classified by acuity (elective versus urgent). We assessed practice/urologist variation in urgent ureteroscopy performance. We characterized patients demographic, operative and outcomes data, making bivariate comparisons with elective ureteroscopy to understand implications of urgent surgery. We performed multilevel modeling to understand factors associated with unplanned healthcare encounters after urgent ureteroscopy. 12,859 cases were identified from 33 practices and 204 urologists, 10,854 (84.4%) elective and 2005 (15.6%) urgent. Urgent ureteroscopy was performed on younger patients (53 vs 57, p < 0.001), with higher rates of ureteral stones (72.8% vs 56.8%, p < 0.001). Urgent ureteroscopy rates varied widely by practice (2-70%) and urologist (0-98%). Urgent ureteroscopy had higher stenting rates (77.4% vs 72.5%, p < 0.001), stone free rates (66% vs 58.4%, p < 0.001), and postoperative ED visits (11% vs 7.2%, p < 0.001). There were no differences in intraoperative complications or unplanned hospitalizations. Factors predictive of ED visits in urgent ureteroscopy included concomitant ureteral/renal stone location (OR = 1.53, CI = 1.05-2.23, p = 0.035). In Michigan elective ureteroscopy is performed 5 times more frequently than urgent ureteroscopy with wide variation. Urgent ureteroscopy demonstrated low morbidity. Urgent ureteroscopy produced modestly higher stone free rates with a slightly increased frequency of unscheduled ED visits particularly for ureteral stones.

978 Evaluation of the Quality of Our Consent Forms Used for Ureteroscopy and Nephroureteroscopy - Is It Time to Go Digital?

Abstract Aim Consent documentation for surgical procedures must be precise and clear in order to achieve excellence in clinical practice. In this audit, we aim to compare our consent forms against BAUS information leaflets on ureteroscopy and stone procedure and assess the documentation of all serious and frequently occurring complications as mentioned on BAUS leaflet. Method We retrospectively reviewed the consent forms of 60 patients who underwent elective ureteroscopy between August 2020 - April 2021 to assess the quality of documentation as well as legibility of handwriting. Results As a total of 60 consent forms were reviewed. 35 males and 25 females contributed to the study with 59 being the median age. There were over 10 risks being commonly missed. Some of the important risks such as stone recurrence 95%, catheterisation 92%, major damage to ureter wall 86%, pain 71% and residual stone 61% were missed. The documentation also outlines other risks; ureteric stricture 53%, aesthetic risk 67%, failure to access ureter 51% and stent symptoms 47%. Minor damage to the wall of ureter 41%, alongside need of another surgery were recorded as other commonly neglected risks. However, only 7% of the consent forms did not mention bleeding and just 2% of the forms failed to include stent insertion as a common effect of procedure. Only 17% consent for did not have eligible handwriting, although this is subjective. Conclusions Documentation on consent forms for ureteroscopy lacks accuracy and missed important information. We propose use of digital consent form to assess compliance and quality of consent documentation.

975 Evaluation of the Quality of Our Consent Forms Used for Ureteroscopy and Nephroureteroscopy - Is It Time to Go Digital?

Abstract Aim Consent documentation for surgical procedures must be precise and clear in order to achieve excellence in clinical practice. In this audit, we aim to compare our consent forms against BAUS information leaflets on ureteroscopy and stone procedure and assess the documentation of all serious and frequently occurring complications as mentioned on BAUS leaflet. Method We retrospectively reviewed the consent forms of 60 patients who underwent elective ureteroscopy between August 2020 - April 2021 to assess the quality of documentation as well as legibility of handwriting. Results As a total of 60 consent forms were reviewed. 35 males and 25 females contributed to the study with 59 being the median age. There were over 10 risks being commonly missed. Some of the important risks such as stone recurrence 95%, catheterisation 92%, major damage to ureter wall 86%, pain 71% and residual stone 61% were missed. The documentation also outlines other risks; ureteric stricture 53%, aesthetic risk 67%, failure to access ureter 51% and stent symptoms 47%. Minor damage to the wall of ureter 41%, alongside need of another surgery were recorded as other commonly neglected risks. However, only 7% of the consent forms did not mention bleeding and just 2% of the forms failed to include stent insertion as a common effect of procedure. Only 17% consent for did not have eligible handwriting, although this is subjective. Conclusions Documentation on consent forms for ureteroscopy lacks accuracy and missed important information. We propose use of digital consent form to assess compliance and quality of consent documentation.

MP05-10 MIXING IT UP: ARE PATIENTS WITH MIXED URINE CULTURES AT HIGHER RISK OF POSTOPERATIVE SEPSIS AFTER URETEROSCOPY?

You have accessJournal of UrologyCME1 May 2022MP05-10 MIXING IT UP: ARE PATIENTS WITH MIXED URINE CULTURES AT HIGHER RISK OF POSTOPERATIVE SEPSIS AFTER URETEROSCOPY? Young Son, Julia Scali, Ian Madison, Benjamin Fink, Katelyn Klimowich, Dayna DeVincentz, Paul Chialastri, and Thomas Mueller Young SonYoung Son More articles by this author , Julia ScaliJulia Scali More articles by this author , Ian MadisonIan Madison More articles by this author , Benjamin FinkBenjamin Fink More articles by this author , Katelyn KlimowichKatelyn Klimowich More articles by this author , Dayna DeVincentzDayna DeVincentz More articles by this author , Paul ChialastriPaul Chialastri More articles by this author , and Thomas MuellerThomas Mueller More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002522.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteroscopy with laser lithotripsy has been used for the treatment of ureteral calculi since the 1980s. Life-threatening urosepsis is one of the most severe complications of this procedure. The American Urological Association (AUA) recommends single-dose antibiotic prophylaxis prior to ureteroscopic stone removal. The significance of colonization in an asymptomatic patient is unknown at this time. Our objective is to determine if preoperative urine cultures with mixed flora on microbiology report, have a higher rate of postoperative sepsis than patients with negative cultures for uncomplicated elective ureteroscopy with laser lithotripsy. METHODS: A retrospective multi-institutional chart review was performed on 306 patients for which procedure code included elective ureteroscopy with lithotripsy from April 2018 until December 2020. Patients were excluded if the mixed urine cultures were treated with antibiotic therapy, inpatient setting, or had percutaneous nephrostomy or nephroureterostomy tubes. Mixed cultures were defined as mixed culture >10,000 CFU (colony forming unit) and positive cultures were defined as bacteria with >100,000 CFU. RESULTS: The overall sepsis rates were 3% with negative culture preoperatively, 10.9% with a mixed culture, and 19.2% with positive culture. There was a significant difference in carbonate apatite composition between mixed culture group and negative culture group (p=0.02) and positive culture group and negative culture group (p=0.01) (Table 1). There was an increased stent duration 38.4 days compared to 16.6 days in septic vs. non-sepsis group (p<0.002). There were discordinate amount of carbonate apatite composition with 37.7% in the sepsis group compared to 14.2% in the non-sepsis group (p=0.003) (Table 2). CONCLUSIONS: We conclude that there is 3.6 times more likely that postoperative sepsis patients had mixed cultures compared to negative cultures. Also, there was 2.7 times more carbonate apatite stone composition in postoperative sepsis group compared to non-sepsis group. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e71 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Young Son More articles by this author Julia Scali More articles by this author Ian Madison More articles by this author Benjamin Fink More articles by this author Katelyn Klimowich More articles by this author Dayna DeVincentz More articles by this author Paul Chialastri More articles by this author Thomas Mueller More articles by this author Expand All Advertisement PDF DownloadLoading ...

Comparison Of Emergency And Elective Intervention With Semi-Rigid Ureteroscopic Lithotripsy For Patients With Ureteral Calculi.

Ureteroscopy (URS) is a safe and highly effective treatment option for treatment of ureteral calculi. With the advancement of technology, there is also expansion of its indications including use in early or emergency setting. This study aims to compare safety and efficacy of emergency ureteroscopy (EmURS) versus elective ureteroscopy (ElURS) for ureteral stones. Patients with unilateral single radio-opaque ureteral stone who underwent semi-rigid URS from January 2008 till December 2019 were included. Patients with solitary kidney, uro-sepsis, pregnancy or pre-operative drainage with nephrostomy or JJ stent were excluded. EmURS was defined as URS being performed within 48 hours of presentation, while ElURS was defined as URS performed after failed medical expulsive therapy. Patient, stone and outcome related variables were compared in both groups. Stone free rate was defined as no evidence of stone on plain x-ray KUB after 1 week. We compared 132 patients in EmURS group against 264 in ElURS group. Age, gender, comorbidities, stone location, laterality and mean stone size were comparable in both groups. EmURS had a less median operative time (p=0.05). Stone free rate achieved was 90.2% in EmURS and 87.1% in ElURS, respectively (p=0.38). Double J stent was placed in 44.7% and 46.2% of EmURS and ElURS respectively (p=0.89). Ancillary procedures were performed in 9.8% of EmURS and 11.7% of ElURS (p=0.57). Overall complication rates were reported in 7.6% in EmURS and 11.7% in ElURS (p=0.22) and most were Clavien grade 1. Emergency URS for ureteral stones is a safe and effective one-stage definitive treatment option for patients with acute renal colic not responding to conservative management.

Outcome of elective versus emergency ureteroscopic stone surgery: Challenges in the post GIRFT era

Aim: To assess the safety, efficacy, stone clearance rate and challenges posed when providing an emergency stone service as recommended by the Getting It Right First time (GIRFT) report. Methods: Retrospective analysis of the emergency and elective stone service carried out by a single dedicated stone endourologist in a district general hospital over a 4 year period. 52 patients undergoing emergency ureteroscopy (EMURS) were matched with 52 similar patients undergoing elective ureteroscopy (ELURS) and their outcomes were compared. A sub-group of 8 high risk patients who underwent EMURS were analysed separately. Results: Target stone clearance was identical in both groups at 98.1%. Complete stone clearance in the EMURS group was 90.3% compared to 96.1% in the ELURS group. There was no increase in operative time in the EMURS group with a mean time of 38.9 minutes compared to 50.2 minutes in the ELURS group. Low complication rates were seen with a 2% complication rate in patients having ELURS compared to 8% for those undergoing EMURS. The sub-group of high risk patients had a target stone clearance rate of 100% with a complete stone clearance rate of 75%. No complications were seen in this group. Conclusion: Emergency ureteroscopy is a safe procedure with low complication rates. This should therefore be offered to patients as the gold standard of care in appropriately selected patients presenting acutely with ureteric colic. The GIRFT recommendations to provide emergency stone surgery can be followed with good outcomes achievable.

Emergency versus elective ureteroscopy for the management of ureteral stones.

To assess the safety and efficacy of emergency ureteroscopy (URS) compared with elective URS. We conducted a retrospective analysis of patients who underwent URS for isolated ureteral stones in a single center from October 2001 to February 2014. Our patient cohort was divided into two groups: an emergency URS group (Group A), which consisted of patients who underwent URS within the first 24 h of admission, and an elective or planned URS group (Group B). The URS success rate was defined as being the incidence of successful stone fragmentation and whether there was resolution of renal obstruction. A total of 2957 patients' medical records were available for analysis. Of these, 704 (21%) comprised of emergency cases and the remaining 2253 (79%) were elective cases. Patients in Group A were younger, had a smaller BMIs, and had smaller stone sizes (p < 0.001). The URS success rate was found to be 97% in Group A and 96% in Group B (p = 0.35). Intraoperative or postoperative complication rates were not found to vary significantly between the groups (8% vs 7%, respectively, p = 0.50). The incidence of ureteral stenting was nearly twice as high if URS was performed during night hours (85% vs 45%, p < 0.001). However, ureteral stenting was more prevalent in Group B compared to Group A patients (57% vs 25%, p < 0.001), possibly as a result of the number of pre-stented patients (73%). Emergency URS is an effective and safe option for patients with renal colic. Younger patients without pre-existing obesity and with stone sizes up to 8 mm located in the distal ureter might be a better match for emergency URS.

Ureteroscopy in the day case setting: it’s worth it! Retrospective single surgeon outcomes analysis during service relocation (inpatient to daycase) in a DGH

Objective: Due to advances in surgical techniques and anaesthesia, day surgery is now becoming the standard care pathway for many complex procedures traditionally treated through inpatient pathways. Our aim was to study outcomes for patients undergoing rigid and flexible ureteroscopy before and after moving this service from a district general hospital to a day surgery unit. Methods: This was a retrospective observational study of 136 consecutive patients undergoing elective ureteroscopy for stone treatment. Half of the patients ( n=68, inpatient group) underwent treatment according to the standard inpatient pathway, while the other half underwent treatment following relocation of this service to a day case unit ( n=68, day case group). Outcomes were length of stay, readmission rate and complications. Results: In the inpatient group, 12 patients (17.6%) were discharged home the day of surgery (day 0), 42 patients (61.8%) stayed in hospital for one night. In the day case group, 58 patients (85.3%) were discharged on day 0, nine patients (13.2%) stayed for one night. Length of stay in the day case group was significantly shorter ( P&lt;0.001). Rates of postoperative complications and readmissions were not significantly different. Conclusion: Day case ureteroscopy for stone treatment is feasible and safe. It is associated with a significantly reduced length of stay without an increase in postoperative complications or readmission.

Emergency vs elective ureteroscopy for a single ureteric stone

ABSTRACT Objective To compare emergency with elective ureteroscopy (URS) for the treatment of a single ureteric stone. Patients and methods The files of adult patients with a single ureteric stone were retrospectively reviewed. Patients with fever or turbid urine on passage of the guidewire beside the stone underwent ureteric stenting or nephrostomy drainage. Patients who underwent URS were included and divided into two groups: the emergency (EM) Group, those who presented with persistent renal colic and underwent emergency URS within 24 h; and the elective (EL) Group, who underwent elective URS after ≥14 days of diagnosis. Patients with ureteric stents were excluded. The technique for URS was the same in both groups. Safety was defined as absence of complications. Efficacy was defined as the stone-free rate after a single URS session. Results From March 2015 to September 2018, 179 patients (107 in the EM Group and 72 in the EL Group) were included. There were significantly more hydronephrosis and smaller stones in the EM Group (P = 0.002 and P = 0.001, respectively). Laser disintegration was needed in more patients in the EL Group (83% vs 68%, P = 0.023). Post-URS ureteric stents were inserted in more patients in the EM Group (91% vs 72%, P = 0.001). Complications were comparable for both groups (4.2% for EL and 5.6% for EM, P = 0.665). Stone-free rates were also comparable (93% in the EL Group and 96% in the EM Group, P = 0.336). Conclusions Emergency URS can be as safe and effective as elective URS for the treatment of a single ureteric stone if it is performed in patients without fever or turbid urine. Abbreviations: EL Group: elective group; EM Group: emergency group; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; MET: medical expulsive therapy; NCCT: non-contrast CT; SFR: stone-free rate; SWL: shockwave lithotripsy; URS: ureteroscopy

PT261 - Emergency versus elective ureteroscopy: Retrospective analysis of 4021 cases

PT261 - Emergency versus elective ureteroscopy: Retrospective analysis of 4021 cases

30] Outcomes of emergency vs elective ureteroscopy for a single ureteric stone

ObjectiveTo compare the results of emergency vs elective ureteroscopy (URS) for the treatment of a single ureteric stone.

Outcomes of Elective Ureteroscopy for Ureteric Stones in Patients with Prior Urosepsis and Emergency Drainage: Prospective Study over 5 yr from a Tertiary Endourology Centre

BackgroundElective treatment of ureteric stones is needed after emergency drainage of urosepsis. ObjectiveWe wanted to look at the outcomes of elective ureteroscopic stone treatment in patients with prior sepsis and emergency drainage via retrograde ureteric stent (RUS) or percutaneous nephrostomy (PCN). Design, setting, and participantsData of all patients who underwent elective ureteroscopy (URS) for stone disease over 5 yr (March 2012–December 2016) were prospectively collected. InterventionElective URS following previous emergency RUS or PCN. Outcome measurements and statistical analysisOutcomes were collated for consecutive patients who underwent emergency drainage for urosepsis secondary to stone disease, followed by elective URS. Data was collected regarding patient demographics, stone parameters, and clinical outcomes. Statistical analysis was performed using SPSS version 24. Results and limitationsIn total, 76 patients underwent 82 elective procedures (six underwent bilateral URS) with a male to female ratio of 1:2 and a mean age of 57 yr. Emergency decompression was achieved via RUS in 63 (83%) and PCN in 13 (17%) patients. A positive urine culture on presentation was obtained in 26 (34%) patients, and 27 (36%) patients were admitted to the intensive care unit (ICU). The mean single and overall stone size was 8.6 (2–23) and 10.8 (2–32) mm, respectively. The mean operating time was 42 (5–129) min with stone-free rate (SFR) of 97% (n=74). There were three (4%) complications in total, of which two patients developed urinary tract infection needing intravenous antibiotics (Clavien II) and a third developed sepsis (Clavien IV) needing ICU admission. There was no difference in ureteroscopic lithotripsy outcomes (operative time, complications, or SFR) on comparing initial RUS or PCN, admission to ICU or ward, positive or negative urine culture result, presence of single or multiple stones, and between American Society of Anaesthesiologists (ASA) grade of patients. The ASA grade of patients was a significant predictor of day case procedures (p=0.001). ConclusionsElective URS achieved excellent outcomes in patients who previously presented with obstructing calculi and sepsis needing emergency decompression. Overnight inpatient admission was needed in some patients with a higher ASA grade. Patient summaryIn this report, we look at the outcomes of planned ureteroscopy procedures for stone disease in patients with previous urosepsis. These patients with previous emergency drainage for urosepsis had excellent outcomes from their planned ureteroscopic surgery. This information will help in preoperative patient optimisation and counselling.