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OBJECTIVE: To assess the safety and efficacy of emergency ureteroscopy (URS) compared with elective URS. METHODS: 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. RESULTS: 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%). CONCLUSIONS: 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.
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Litotricia , Cólico Renal , Cálculos Ureterales , Humanos , Estudios Retrospectivos , Resultado del Tratamiento , Cálculos Ureterales/cirugía , UreteroscopíaRESUMEN
BACKGROUND: Primary ureteroscopy (P-URS) has been shown to be as safe and as efficacious as preoperative stent insertion followed by a delayed ureteroscopy (D-URS). However, studies are of limited patient cohort. METHODS: A prospective study comparing P-URS and laser fragmentation for ureteric stones to those who received a stent insertion followed by D-URS and stone fragmentation. RESULTS: A total of 367 consecutive patients were included. P-URS was conducted on 235 patients and D-URS on 132 patients. There was no overall difference between patient or stone demographics between the 2 groups, although there were more proximal ureteric and pelvi-ureteric junction stones in the preoperative stent group. The mean operative times were comparable with a stone free rate of 97 and 94% in the preoperative stent and no-stent groups, respectively. The overall complication rates were comparable. CONCLUSION: The current study provides evidence for the feasibility, safety, and efficacy of P-URS for ureteric calculi in a publicly funded healthcare setting with results comparable to those patients with a preoperative stent and delayed procedure. Therefore, cumulatively, P-URS could lead to less hospitalization, length of stay, stent-related morbidity, and ultimately will be more cost-effective.
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Tiempo de Tratamiento , Cálculos Ureterales/cirugía , Ureteroscopía , Adulto , Anciano , Femenino , Humanos , Terapia por Láser , Masculino , Persona de Mediana Edad , Estudios Prospectivos , StentsRESUMEN
INTRODUCTION: Immediate ureteroscopic treatment for patients presenting to the emergency room with symptomatic ureterolithiasis is more commonly being utilized. Recent reports demonstrate good efficacy for emergency ureteroscopy (URS); however, preoperative predictors of treatment success have not been described. In this study, we report our multicenter experience with emergency URS and identify predictors of successful treatment. We also describe the Emergency Ureteral Stone Treatment (EUST) score, which integrates these predictors and stratifies patients into those that are likely and unlikely to have successful treatment. MATERIALS AND METHODS: Laboratory and radiographic data for all patients who underwent emergency URS for acute symptomatic ureterolithiasis from 2010 to 2015 were reviewed. Statistical difference among parameters for patients who were stone free (SF) and not SF was assessed with the Student's t-test. Cutoff values for significant predictors were determined using sensitivity and specificity analysis. The EUST score was determined based on the number of cutoffs a patient was below. RESULTS: Two hundred two of 247 patients (81.8%) were SF. Two complications (ureteral perforation) occurred. Stone size, duration of symptoms before presentation, and serum white blood count at presentation did not affect SF rates. 95.5% of the treatment failures were attributed to a tight ureter preventing stone access. Patients who received alpha blockers before treatment were more likely to be SF (98.0% vs 55.5%, p < 0.01). Periureteral density (PUD) was lower in SF patients (2.8 HU vs 19.6 HU, p < 0.01), whereas the increase in serum creatinine from baseline (ΔCr) was greater in non-SF patients (0.44 mg/dL vs 0.20 mg/dL, p < 0.01). EUST score of 0, 1, and 2 correlated with SF rates of 20.6%, 81.9%, and 99.2%, respectively. CONCLUSIONS: Combined consideration of PUD and ΔCr with the EUST score can assist in selecting optimal candidates for immediate ureteroscopic management. Administration of alpha blockers before surgery may improve success rates by providing preoperative ureteral dilation.