Are Endourologists More Likely to Definitively Treat Symptomatic Stones at Initial Presentation?
Mouneeb M. Choudry, Christopher C. Ballantyne, Ashley Vaughan, Victoria S. Edmonds, Jackson Cabo, Kimberly Maciolek, Srinath-Reddi Pingle, Harrison M. Drebin, Runhan Ren, Cesar Delgado, Joanna Langner, Dominic Franceschelli, Ethan Mills, Othmane Zekraoui, Michelle Taillefer, Bodo Knudsen, Ojas Shah, Nicholas L. Kavoussi, Ben H. Chew, Roger Sur, Naeem Bhojani, Mitchell R. Humphreys, Karen L. SternIntroduction:
Ureteral stones are a common cause of emergency presentations. Definitive stone removal at the index encounter can reduce delays and repeat interventions. It is unknown whether fellowship-trained endourologists are more likely to perform definitive management than general/other subspecialist urologists. This multicenter retrospective cohort study evaluated the influence of endourology subspecialty training on the choice between upfront definitive stone treatment and initial ureteral decompression at first presentation. Patients managed with medical expulsive therapy alone were not included.
Methods:
Adults (≥18 years) presenting at 2022 to seven North American academic centers with symptomatic, noninfected, computed tomography-confirmed ureteral stones were included. Patients with infection, sepsis, positive nitrites, or intraoperative pyelonephritis were excluded from the study. Variables included demographics, stone size and location, subspecialty of the on-call urologist, and management type (definitive [ureteroscopy or shockwave lithotripsy]
Results:
Among the 395 patients, 190 (48.0%) underwent definitive management and 205 (52.0%) underwent deferred treatment. Distal stones were treated definitively more often than proximal stones were (51.1%
Conclusions:
Endourologists were more than three times more likely to perform definitive interventions for symptomatic, noninfected ureteral stones at initial presentation. Subspecialty expertise and timely operative access enable safe, efficient, single-stage management.