Primary ureterorenoscopic treatment of ureteric stones for renal colic. A snapshot from practice at a District General Hospital
Jamie Varun Krishnan, James Lucocq, Sami Hamid, Lucy Drummond, Slawomir Grzegorz Kata, Richard Alexander Chapman, Robyn Webber, Stephanie Guillaumier, Feras Al JaafariIntroduction:
Across the UK, patients presenting with a stone obstructing the ureter or renal pelvis are often temporized with a stent instead of undergoing primary uretero-renoscopy (pURS) or lithotripsy to treat the offending stone. This may be due to issues with staffing or equipment or the view that it is a solution to the patient's immediate problem. This necessitates a further operation, and the morbidity associated with that, alongside the morbidity of living with a stent in situ and the associated costs. Getting it Right First Time, therefore, recommends definitive treatment within an appropriate timescale instead of stenting. This study aims to audit the management of acute presentations of urolithiasis in a National Health Service Trust in Scotland.
Methods:
A retrospective review of 85 consecutive patients presenting with obstructing urolithiasis requiring operative intervention on the index admission between January 2021 and January 2022 was performed; assessing patient and stone characteristics, choice of intervention (stent vs pURS), and operative outcomes.
Results:
85 patients were identified: 31 (36%) underwent pURS, and 54 (64%) underwent stent placement. Full-stone clearance was achieved in 30 (96%) of patients undergoing pURS, while mean waiting time until definitive treatment was 86 days for those stented. Twenty-eight (90%) of the pURS were performed by a trainee. Univariate and multivariate logistic regression identified infection (OR: 0.04; p = 0.003) and proximal stones (OR: 0.27; p = 0.028) were negatively associated with associated with pURS, while an endourology subspecialist consultant on-call was positively associated with pURS (OR 3.73; p = 0.019).
Discussion:
Proximal stones and infection are the main drivers toward stenting, while an on-call endourologist skews toward pURS, which is safe and feasible, and should be the preferred option for intervention in the absence of infection and can be used as a training opportunity.