Emergency versus elective ureteroscopic treatment of ureteral stones

Abstract

Introduction: This retrospective study investigates the role of the emergency ureteroscopic (URS) approach in the definitive treatment of ureteric stones. Methods: We reviewed all patients admitted for ureteric stones from May 2003 to December 2010. Those who underwent URS stone treatment were selected and stratified into emergency (EMG) and elective groups (ELG). Emergency URS is defined as URS being performed within 24 hours of admission to the emergency room. The main indication for emergency treatment was refractory ureteric colic in spite of narcotic analgesia. Both groups were statistically compared in terms of their patient-, stone-and outcome-related variables. The overall success rate was defined by the clearance of the stone and/or presence of residual fragments (<3 mm) at the end of 4-week follow-up period. Results: In total, 903 patients were suitable for analysis with 244 and 659 patients in the EMG and ELG, respectively. Age, sex and comorbidities were comparable in both groups. Average ages were 43.4 ± 15.31 and 45.6 ± 13.24 years among EMG and ELG, respectively. Stones had an average size of 0.92 ± 0.49 (in the EMG group) and 0.96 ± 0.53 cm (in the ELG group). We found that 61.1% and 65.7% of stones were distally located in the EMG and ELG, respectively. EMG had a longer operative time (69 ± 21.03 vs. 57 ± 13.45 minutes) with comparable average hospital stays (1.9 days). Intra-operative double-J stents or ureteric catheter insertion was noted in 72.5 and 67.7% of EMG and ELG, respectively. The overall complication rates were reported in 13.1% in EMG and 14.4% in ELG. A higher rate of ureteric injuries (early and late) was documented in the EMG group (7% vs. 5.6%). Most of these injuries were minor and manageable without additional procedure and/or general anesthesia. Success was achieved in 90.6% and 91.8% of the EMG and ELG groups, respectively. Conclusion: With recent advances in technology, the growing trend toward one-stage definitive treatment, patient acceptability and rising concerns over financial aspects, emergency URS treatment of ureteric stones is evolving as a standard initial management option.

Comparison of Primary and Delayed Ureteroscopy for Ureteric Stones: A Prospective Non-Randomized Comparative Study

“…Availability of staff with a sub-speciality interest in stone surgery may also have influenced our high stone free rates. Our stone free rate also compared favourably to other emergency ureteroscopic management studies (89–98%) [7-10].…”

Emergency vs elective ureteroscopy for a single ureteric stone

“…This was also reported in all previously published comparative studies [9,11,13,15,16]. The reported SFR of emergency URS ranged between 81% and 93% [8,9,[11][12][13][15][16][17][18]. We achieved a better SFR (96%) due to the use of laser lithotripsy in all cases.…”

Emergent versus delayed lithotripsy for obstructing ureteral stones: a cumulative analysis of comparative studies

“…The definition of emergency varied among the studies from 12 to 48 h from admission to the emergency room. Stone-free status was defined on postoperative imaging (KUB in 3 studies and CT scan in one), which was done at 1 month in most studies (Table 1) [16][17][18][19]. In six studies (4 prospective randomized controlled and 2 retrospective case-control studies), emergent ESWL (n = 356) was compared to delayed ESWL (n = 355).…”

“…An overall 5% complication rate was reported by a recent large audit form New Zealand [31]. In the four comparative studies, we identified and included only two major complications, which were reported by Matani et al, who had one ureteral perforation and one avulsion caused by stone basket [19].…”

“…Youn [16] Mucosal Injury (I) 3 (4.5%) 9 (5.6%) Haematuria (I) -6 (3.7%) Guercio [17] Haematuria (I) 1 (0.7%) -Urinary tract infection (II) 1 (0.7%) 1 (1%) Ureteral stricture (I) -1 (1%) Sarica [18] Mucosal injury (I) 6 (7.9%) 2 (2.9%) Haematuria (I) 3 (3.9%) -Matani [19] Flank and early ESWL (86.3 versus 80%; p = 0.31), although they only included upper ureteral stones <10 mm. Notably, in this study, the need of auxiliary procedure and number of ESWL sessions was significantly lower when ESWL is performed within the first 48 h [22].…”