Primary Ureteroscopy in the definitive management of ureteric stones - Experience at a UK Tertiary Referral Stone Center
Author(s):
Mr Michael Wanis
,
Mr Michael Wanis
Affiliations:
Mr Simon Mackie
,
Mr Simon Mackie
Affiliations:
Mr Shwan Ahmed
,
Mr Shwan Ahmed
Affiliations:
Mr Graham Watson
Mr Graham Watson
Affiliations:
BAUS ePoster online library. Wanis M. 06/26/17; 177361; P3-5 Disclosure(s): None declared
Mr. Michael Wanis
Mr. Michael Wanis
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Abstract
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Introduction

Patients presenting acutely with ureteric colic in the UK are often discharged to await definitive surgery or ESWL if symptoms resolve. However, those with persistent pain or infection often face a period of ureteric stenting whilst awaiting definitive surgery. This approach exposes patients to two general anaesthetics and considerable stent morbidity. We have adopted a model of primary ureteroscopy at first admission for such patients as well as those with risk factors including solitary kidney, bilateral ureteric stones, renal transplant and chronic kidney disease. We examined the outcomes of this model.


Materials and methods

Patients presenting with ureteric stones with and without infection, requiring surgical management, from July to December 2016, at our institution, were included. Treatment outcomes and referral-to-treatment (RTT) times were evaluated.


Results

Sixty-nine patients with ureteric stones underwent ureteroscopy over this 6-month period. Percutaneous access was necessary in 4%. 17/69 presented with infection, requiring initial decompression.

96% of patients with non-infected ureteric stones underwent primary ureteroscopy (95% stone clearance). 82% of patients with infection underwent initial decompression followed by ureteroscopy at the same admission (88% stone clearance) with a median length of stay (LoS) of 7 days. 22% required stenting at ureteroscopy overall.

Overall median LoS was 1 day and RTT time 23 days. 8.7% had postoperative complications and 5.8% were readmitted.


Conclusions

Primary ureteroscopy is safe, offering a high stone clearance and low stent rate, whilst reducing RTT times. Furthermore, patients presenting with infection can undergo definitive treatment safely at primary admission.
Introduction

Patients presenting acutely with ureteric colic in the UK are often discharged to await definitive surgery or ESWL if symptoms resolve. However, those with persistent pain or infection often face a period of ureteric stenting whilst awaiting definitive surgery. This approach exposes patients to two general anaesthetics and considerable stent morbidity. We have adopted a model of primary ureteroscopy at first admission for such patients as well as those with risk factors including solitary kidney, bilateral ureteric stones, renal transplant and chronic kidney disease. We examined the outcomes of this model.


Materials and methods

Patients presenting with ureteric stones with and without infection, requiring surgical management, from July to December 2016, at our institution, were included. Treatment outcomes and referral-to-treatment (RTT) times were evaluated.


Results

Sixty-nine patients with ureteric stones underwent ureteroscopy over this 6-month period. Percutaneous access was necessary in 4%. 17/69 presented with infection, requiring initial decompression.

96% of patients with non-infected ureteric stones underwent primary ureteroscopy (95% stone clearance). 82% of patients with infection underwent initial decompression followed by ureteroscopy at the same admission (88% stone clearance) with a median length of stay (LoS) of 7 days. 22% required stenting at ureteroscopy overall.

Overall median LoS was 1 day and RTT time 23 days. 8.7% had postoperative complications and 5.8% were readmitted.


Conclusions

Primary ureteroscopy is safe, offering a high stone clearance and low stent rate, whilst reducing RTT times. Furthermore, patients presenting with infection can undergo definitive treatment safely at primary admission.
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