INTRODUCTION AND OBJECTIVES: The aim of this study is to investigate the role of emergency ureteroscopy (eURS), in the definitive treatment of ureteric stones and to determine the factors predicting favorable results. METHODS: We retrospectively analyzed all the patients underwent eURS from January 2012 throught December 2014 by the same surgeon. Only patients presenting with a first episode of ureteric colic were included in the study. All the procedures were performed within 48 hours from the presentation to the emergency room. Laser litotripsy, basket stone removal and ureteral stenting were performed when necessary. The database included: age, gender, anthropometric parameters, side of disease, position of the stone, size of the stone, presence of hydronephrosis, serum creatinine, urinalysis and pretreatment imaging. Operative time, hospitalization, complications, stone free status (SFR) and need for auxiliary procedures were evaluated. Regarding the results, patients were separated into two groups, Gr1 had successful eURS and Gr2 failed their tretment and needed auxiliary procedures (ESWL or URS). The collected data were analyzed using SPSS software with the purpose to assess the efficacy of the procedure and the presence of factors predicting favorable results. RESULTS: Of the 212 patients underwent eURS the mean stone size was 6.72 mm (6.55 mm in Gr1 and 7.70 mm in Gr2) and most of them were located in the distal ureter 64.1% (75.3% in Gr1 and 34,5% in Gr2). 72.1% of the patients had hydronephrosis at diagnosis (18.3% severe). 154 patients (72.6%) were stone free after eURS (Gr1) and 58 patients (27.4%) failed treatment and went on to have a secondary procedure (Gr2). SFR for proximal and distal stones was 50% and 85.3% respectively. SFR for distal stones smaller than 7 mm reached 90%. Ureteral stenting was slightly higher in Gr2 than in Gr1, 96.6% vs 89.6% respectively. The mean operative time and hospitalization time was comparable in both groups, 43.1 min and 3.4 days in Gr1 and 32.6 min and 3.9 days in Gr2. Complications rate was higher in Gr2 than in Gr1, 17.2% and 7.8% respectively; no patient experienced major perioperative and postoperative complications. CONCLUSIONS: In our experience, immediate ureteroscopy for ureteral stone colic proved to be safe and effective, offering both immediate stone fragmentation and pain relief. The success rate of the procedure is higher in patients with smaller stones (<7mm) and located in the distal ureter. A subgroup of younger and healthier patients benefit the most from the procedure.

MP51-05 FACTORS PREDICTING SUCCESS OF EMERGENCY URETEROSCOPIC TREATMENT OF URETERAL STONES: A 3 YEARS SINGLE CENTER EXPERIENCE IN 212 PATIENTS

Umari, Paolo;Bucci, Stefano;Rizzo, Michele;Pavan, Nicola;Liguori, Giovanni;Trombetta, Carlo
2016

Abstract

INTRODUCTION AND OBJECTIVES: The aim of this study is to investigate the role of emergency ureteroscopy (eURS), in the definitive treatment of ureteric stones and to determine the factors predicting favorable results. METHODS: We retrospectively analyzed all the patients underwent eURS from January 2012 throught December 2014 by the same surgeon. Only patients presenting with a first episode of ureteric colic were included in the study. All the procedures were performed within 48 hours from the presentation to the emergency room. Laser litotripsy, basket stone removal and ureteral stenting were performed when necessary. The database included: age, gender, anthropometric parameters, side of disease, position of the stone, size of the stone, presence of hydronephrosis, serum creatinine, urinalysis and pretreatment imaging. Operative time, hospitalization, complications, stone free status (SFR) and need for auxiliary procedures were evaluated. Regarding the results, patients were separated into two groups, Gr1 had successful eURS and Gr2 failed their tretment and needed auxiliary procedures (ESWL or URS). The collected data were analyzed using SPSS software with the purpose to assess the efficacy of the procedure and the presence of factors predicting favorable results. RESULTS: Of the 212 patients underwent eURS the mean stone size was 6.72 mm (6.55 mm in Gr1 and 7.70 mm in Gr2) and most of them were located in the distal ureter 64.1% (75.3% in Gr1 and 34,5% in Gr2). 72.1% of the patients had hydronephrosis at diagnosis (18.3% severe). 154 patients (72.6%) were stone free after eURS (Gr1) and 58 patients (27.4%) failed treatment and went on to have a secondary procedure (Gr2). SFR for proximal and distal stones was 50% and 85.3% respectively. SFR for distal stones smaller than 7 mm reached 90%. Ureteral stenting was slightly higher in Gr2 than in Gr1, 96.6% vs 89.6% respectively. The mean operative time and hospitalization time was comparable in both groups, 43.1 min and 3.4 days in Gr1 and 32.6 min and 3.9 days in Gr2. Complications rate was higher in Gr2 than in Gr1, 17.2% and 7.8% respectively; no patient experienced major perioperative and postoperative complications. CONCLUSIONS: In our experience, immediate ureteroscopy for ureteral stone colic proved to be safe and effective, offering both immediate stone fragmentation and pain relief. The success rate of the procedure is higher in patients with smaller stones (<7mm) and located in the distal ureter. A subgroup of younger and healthier patients benefit the most from the procedure.
THE JOURNAL OF UROLOGY
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11368/2918851
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