Emergency vs elective ureteroscopy for a single ureteric stone

Al‐Terki, Abdullatif; Alkabbani, Majd; Alenezi, Talal; Al-Shaiji, Tariq F.; Al‐Mousawi, Shabir; El-Nahas, Ahmed R.

doi:10.1080/2090598x.2020.1813004

Cited by 3 publications

(3 citation statements)

References 20 publications

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“…Obesity, which is one of the most important diseases that has been increasing in recent years and threatening health, and in parallel with the sedentary lifestyle and fast-food culture that has increased in this way, stone disease is increasing day by day [ 5 , 12 , 13 ]. Depending on this situation, there is an increase in the rate of admission to the emergency department or urology department due to renal colic [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Urgent ureterorenoscopy as a primary treatment for ureteral stone: why not?

Uğur,

Yağmur

2024

Urolithiasis

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To evaluate the feasibility of urgent ureteroscopy (uURS) and elective ureteroscopy (eURS) in the management of patients with renal colic due to ureteral stones. Patients who were operated for ureteral stones between September 2020 and March 2022 were determined retrospectively. The patients who were operated within the first 24 h constituted the uURS group, while the patients who were operated after 24 h were classified as eURS. No limiting factors such as age, gender and concomitant disease were determined as inclusion criteria. Patients with bilateral or multiple ureteral stones, bleeding diathesis, patients requiring emergency nephrostomy or decompression with ureteral JJ stent, and pregnant women were not included. The two groups were compared in terms of stone-free rate, complications, and overall outcomes. According to the inclusion–exclusion criteria, a total of 572 patients were identified, including 142 female and 430 male patients. There were 219 patients in the first group, the uURS arm, and 353 patients in the eURS arm. The mean stone size was 8.1 ± 2.6. The stone-free rate was found to be 87.8% (502) in general, and 92 and 85% for uURS and eURS, respectively. No major intraoperative or postoperative complications were observed in any of the patients. Urgent URS can be performed effectively and safely as the primary treatment in patients with renal colic due to ureteral stones. In this way, the primary treatment of the patient is carried out, as well as the increased workload, additional examination, treatment and related morbidities are prevented.

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Section: Discussionmentioning

confidence: 99%

Urgent ureterorenoscopy as a primary treatment for ureteral stone: why not?

Uğur,

Yağmur

2024

Urolithiasis

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“…Benefits are seen with intervention within the first 48 h of presentation in terms of stone removal, repeated procedures and stent insertion, leading to substantial cost savings at a population level. Primary URS performed on an emergency basis has been shown to be as safe and effective as elective URS for the management of single ureteric stones in the absence of infection [20].…”

Section: Elective and Emergency Proceduresmentioning

confidence: 99%

Urological stone disease: a 5‐year update of stone management using Hospital Episode Statistics

2022

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To reassess the trends in upper urinary tract (UUT) stone disease burden and management in the UK during the last 5 years. MethodsThe present paper is our third quinquennial analysis of trends in the management of renal stones in England. Data were collected using the Hospital Episode Statistics database for the years 2015-2020 inclusive. These were then analysed, summarized and presented. ResultsThe number of UUT stone episodes increased by 2.2% from 86 742 in 2014-2015 to 88 632 in 2019-2020 but annual prevalence remained static at 0.14%. The number of UUT stone episodes in those of working age has remained static but increased by 9% for patients aged > 60 years (from 27 329 to 29 842). The number of shockwave lithotripsy (SWL) treatments decreased by 6.8%. There was a further increase in the use of ureteroscopy (URS) between 2015 and 2020 of 18.9%. Within this subgroup, flexible URS had the most rapid increase in use, with a rise of 20.4% from 7108 to 8558 recorded cases. Over the 20-year period from 2000 to 2020 there was a remarkable 257% increase in URS cases. There was a further decline in open surgery for UUT stone disease by 40%. Stone surgery day-case numbers have increased by 14.7% (from 31 014 to 35 566), with a corresponding decline in the number of bed days of 14.3%. Emergency cases increased by 40%, while elective cases saw a slight increase of 1.9%. ConclusionThe present study shows a plateauing in the prevalence of UUT stone disease in England in the last 5 years, with a move towards day-case procedures and an increase in the proportion of emergency work. For the first time in England, URS has overtaken SWL as the most common procedure for treating UUT stone disease, which might reflect patients' or physicians' preference for a more effective definitive treatment.

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“…The current surgical practice, however, has huge variations between the centres ranging from emergency treatment with primary intervention such as ureteroscopy, shock wave lithotripsy, percutaneous nephrolithotomy to symptomatic management with a temporary JJ ureteric stent insertion before undertaking scheduled definitive treatment. Safety and efficacy of emergency ureteroscopy have been reported in various studies [ 5 – 8 ], however, there exists uncertainty about whether treating the stone at initial presentation is more cost-effective over symptomatic temporizing stenting management followed by a definitive scheduled elective surgical procedure.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of quality improvement intervention to reduce time between CT-detection and ureteroscopic laser fragmentation in acute symptomatic ureteric stones management

Khopekar,

Nabi,

Shiva

et al. 2024

World J Urol

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Objective To prospectively assess clinical and cost effectiveness of emergency ureteroscopic laser fragmentation of urinary stones causing symptoms or obstruction. Patients and methods 100 consecutive patients with an average (median) age 55.6 (57.5) years and average (median) stone size of 8.2 mm (± 7 mm) between October 2018 and December 2021 who underwent emergency ureteroscopy and laser fragmentation formed the study cohort as part of a clinical service quality improvement. Primary outcome was single procedure stone-free rate and cost-effectiveness. The secondary outcomes were complications, re-admission and re-intervention. A decision analysis model was constructed to compare the cost-effectiveness of emergency ureteroscopy with laser fragmentation (EUL) and emergency temporary stenting followed by delayed ureteroscopy with laser fragmentation (DUL) using our results and success rates for modelling. Results Single procedure stone-free rates (SFR) for EUL and DUL were 85%. The re-intervention rate, re-admission and complication rates of the study cohort (EUL) were 9%, 18%, and 4%, respectively, compared to 15%, 20%, and 5%, respectively for the control cohort (DUL). The decision analysis modelling demonstrated that the EUL treatment option was more cost-efficient, averting £2868 (€3260) per patient for the UK health sector. Total cost of delayed intervention was £7783 (€8847) for DUL in contrast to £4915 (€5580) for EUL. Conclusions Implementation of quality improvement project based on a reduction in CT detection-to-laser fragmentation time interval in acute ureteric obstruction or symptoms caused by stones had similar clinical effectiveness compared to delayed ureteroscopic management, but more cost-effective.

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Emergency vs elective ureteroscopy for a single ureteric stone

Cited by 3 publications

References 20 publications

Urgent ureterorenoscopy as a primary treatment for ureteral stone: why not?

Urgent ureterorenoscopy as a primary treatment for ureteral stone: why not?

Urological stone disease: a 5‐year update of stone management using Hospital Episode Statistics

Cost-effectiveness of quality improvement intervention to reduce time between CT-detection and ureteroscopic laser fragmentation in acute symptomatic ureteric stones management

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