Introduction Failed Access ureteroscopy (FA) describes the inability to gain adequate access to a stone to allow for treatment. The purpose of this study was to identify the prevalence of, and factors predicting FA in patients presenting with renal and ureteral stones. Methods: We performed a retrospective review of all uretersocopies for ureteral stones performed by three endourologists over a six month period. All patients who underwent URS for the purpose of stone treatment were included.  Patients were excluded if they underwent ureteroscopy for non-stone diagnosis or treatment. FA was investigated in relation to demographics, medical history, stone specific characteristics, procedure specific characteristics etc. Statistical analysis consisted of descriptive statistics as well as chi-square and t-test analysis using SPSS statistical software version 23.0. Results: 188 cases were reviewed, with 8% of patients experiencing FA. Patient age, gender, BMI, ASA score, emergency cases, previous stone treatment, use of CT imaging, presence of hydronephrosis, and surgeon did not differ significantly between FA and successful access (SA) groups. Stone size (9.88±5.8 vs 8.76±4.3mm; p=0.361) was also not significantly different. However, a significant difference was noted in time from first diagnosis to ureteroscopy (128 vs 65 days; p=0.044) and in stone location 62.5% vs 22.0% proximal ureter; p=0.043; OR=4.77 (1.05-21.64) Conclusions:  Proximal ureteric stones were more likely to result in failed access ureteroscopy, and FA procedures were more likely to be preceded by extended time from first diagnosis to ureteroscopy. Further investigation is necessary, and all endourology centres should track their own personal outcome data in order to allow for more meaningful analysis to be performed to improve patient outcomes.

Objectives: The objectives of this study have been to: 1) describe and compare urban and rural injured worker populations in Alberta, Canada; 2) identify return-to-work outcomes in urban and rural populations; 3) examine the relationship between geographic location of residence and recovery from work-related musculoskeletal injury; and 4) investigate if this relationship is attenuated after controlling for other known risk factors. Material and Methods: This study was a secondary analysis utilizing data of a population of musculoskeletal injury claimants who underwent clinical/RTW (return to work) assessment between December 2009 and January 2011 collected by the Workers' Compensation Board of Alberta. Descriptive statistics were computed for 32 variables and used for comparing urban and rural workers. The logistic regression analysis was performed to test the association between geographic location of residence and likelihood of return-to-work. Results: Data on 7843 claimants was included, 70.1% of them being urban and 29.9% -rural. Rural claimants tended to have spent less time in formal education, have a blue-collar job, have no modified work available, have a diagnosed comorbidity, and not been enrolled in a specialized rehabilitation program. They were 1.43 (1.12-1.84) times the odds more likely than urban claimants to be continuing to receive full disability benefits 90 days after their RTW assessment, and 1.68 (1.06-2.67) times the odds as likely to report a recurrence of receiving disability benefits. Conclusions: Rural residence was associated with prolonged work disability, even after controlling for age, job type, education level, health utilization and other potential confounders. Further research is required to explore why injured workers in rural settings experience prolonged reception of disability benefits and have greater rates of recurrence of receiving disability benefits. Int J Occup Med Environ Health 2017;30(5):715-729

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