You have accessJournal of UrologyStone Disease: Surgical Therapy VII1 Apr 2017MP75-19 NATIONAL TRENDS IN IMAGING FOLLOWING URETEROSCOPY & SHOCKWAVE LITHOTRIPSY Justin Ahn, Sarah Holt, Philip May, and Jonathan Harper Justin AhnJustin Ahn More articles by this author , Sarah HoltSarah Holt More articles by this author , Philip MayPhilip May More articles by this author , and Jonathan HarperJonathan Harper More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2167AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Imaging after ureteroscopy (URS) and shockwave lithotripsy (SWL) is suggested by the American Urologic Association to ensure stone fragment clearance, resolution of hydronephrosis, and rule out ureteral stricture formation. To our knowledge, no prior studies have examined large-scale national imaging patterns after procedural intervention for nephrolithiasis. We sought to characterize imaging utilization patterns after URS and SWL. METHODS Using Marketscan, a private employer-based insurance database, we identified patients 17-64 years old undergoing URS or SWL between 2007-2014. A minimum of 12 months of enrollment was required and patients were excluded if they received more than 1 lithotripsy procedure of any type within 90 days. Imaging modalities identified by CPT and ICD-9 codes included computed tomography (CT), renal ultrasound (US), abdominal X-ray (KUB), and intravenous pyelogram (IVP), and were tracked postoperatively. Utilization patterns by demographic factors were assessed using chi-squared test. RESULTS A total of 100,710 patients met inclusion criteria following URS, with 39% having no post-operative imaging within 12 months. Only 45% underwent imaging within 3 months of URS, most commonly KUB (28%). At 3, 6, and 12 months, only 26%, 33%, and 42%, respectively, of URS patients had any anatomic imaging (US, CT, or IVP). A total of 109,237 patients met inclusion criteria following SWL, with 16% having no postoperative imaging within 12 months. 78% underwent imaging within 3 months; most commonly KUB (69%). By 3, 6, and 12 months, 19%, 26%, and 36%, respectively, of SWL patients had any anatomic imaging. KUB was the most common imaging modality after either intervention type (38% of URS, 74% of SWL) within 12 months, followed by CT (25% of URS, 24% of SWL), then US (23% of URS, 17% of SWL). Over the 7 year study interval US increased by 10% after URS and 6% after SWL, while CT use decreased by 4%. Older age and female sex were independently associated with higher rates of imaging (p<0.001). US use was 13% higher in the Northeast, and more likely to be utilized in patients in metropolitan statistical areas or enrolled in health maintenance organizations. CONCLUSIONS Despite recommendations for routine imaging after stone procedures, a large proportion of insured patients received none, especially following URS. The majority of URS and SWL patients did not receive any postoperative anatomic imaging, which may raise the risk of undiagnosed ureteral strictures, silent obstruction, and renal function loss. Although RUS use is slowly increasing, it remains underutilized compared to CT. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1011 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Justin Ahn More articles by this author Sarah Holt More articles by this author Philip May More articles by this author Jonathan Harper More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...