Randomized Prospective Trial Comparing Immediate Versus Delayed Ureteroscopy for Patients with Ureteral Calculi and Normal Renal Function Who Present to the Emergency Department

Guercio, S.; Ambu, A.; Mangione, Francesco; Mari, M.; Vacca, Francesca; Bellina, M.

doi:10.1089/end.2010.0554

Cited by 40 publications

(30 citation statements)

References 24 publications

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“…Both studies have strongly recommended the emergency URS approach. 28,31 Failure rates ranged from 6.5% to 10% in both studies. The use of stents was also popular.…”

Section: Discussionmentioning

confidence: 85%

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Emergency versus elective ureteroscopic treatment of ureteral stones

Matani

Al-Ghazo

Al-Azab

et al. 2013

CUAJ

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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.

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“…Both studies have strongly recommended the emergency URS approach. 28,31 Failure rates ranged from 6.5% to 10% in both studies. The use of stents was also popular.…”

Section: Discussionmentioning

confidence: 85%

“…Higher use of double-J stents was reported in the elective surgery group (80% vs. 19.4%). 31 Our study has its limitations. It is retrospective and not controlled.…”

Section: Discussionmentioning

confidence: 89%

Emergency versus elective ureteroscopic treatment of ureteral stones

Matani

Al-Ghazo

Al-Azab

et al. 2013

CUAJ

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“…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).…”

Section: Resultsmentioning

confidence: 99%

“…Al Ghazo et al stratified their 244 cases by stone location, and they found higher stone-free rates for mid (95.8%) and distal ureter (96.6%) compared to distal (69.4%) [30]. Conversely, in the only randomized trial comparing emergent versus delayed URS, Guercio et al found that neither stone size nor location had any impact on stone-free rate [17]. This finding could be explained by the fact that this was the only group to use a flexible scope (besides the semirigid one), and therefore one might expect that a more aggressive pursuit of residual or migrated fragments was implemented.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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Emergent lithotripsy, either ureteroscopic or extracorporeal, can be offered as an effective and safe treatment for patients with symptomatic ureteral stone. If amenable to ESWL, based on stone and patient characteristics, an emergent approach should be strongly considered. Ureteroscopy in the emergent setting is mostly reserved for distally located stones. The implementation of these therapeutic approaches is likely to be dictated by their availability.

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“…This can be attributed to the following factors: failure after a trial of medical expulsion therapy (MET) would lead to the clinical decision for emergency ureteroscopy; the median waiting time for emergency surgery was 26h; and most patients would stay an additional day post-surgery for symptom monitoring before they are discharged. In contrast, EL is performed as Day Surgery procedures [4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Is it Feasible and Cost-Effective to Perform Emergency Ureteroscopic Treatment for Acute Ureteric Colic?

Yeow¹

2017

UNOAJ

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Purpose: Ureteroscopy is one of the treatment options for the management of refractory ureteric colic. Emergency Ureteroscopy can provide significant symptomatic relief and may reduce the number of hospital attendances compared to Elective Ureteroscopy. Data regarding cost, however, is scarce. Materials and Methods:In this retrospective review, all patients who underwent ureteroscopic treatment for ureteric colic in the year 2015 were identified. Patients who underwent ureteroscopic during an emergency admission for acute ureteric colic were classified as having had Emergency Ureteroscopy, while those who underwent elective ureteroscopy for ureteric colic were classified as having had Elective Ureteroscopy. Exclusion criteria included urinary tract infection, sepsis, prior ureteroscopic procedures and/or ureteric stenting. The primary outcome evaluated was cost; secondary outcomes included number of preoperative attendances for colic, operative outcomes and complications, as well as hospital re-attendances.Results: A total of 88 patients were identified, with 31 in the Emergency group, and 57 under the Elective group. EM was associated with significantly higher procedural and overall costs (p <0.001), but reduced hospital attendance for colic (p< 0.001). There were no significant differences between both groups in terms of stone clearance rate and postoperative reattendances. Conclusion:Emergency ureteroscopy management of ureteric colic is a reasonable treatment modality that reduces hospital attendance and has similar treatment outcomes as elective ureteroscopic treatment; albeit associated with higher financial costs.

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Randomized Prospective Trial Comparing Immediate Versus Delayed Ureteroscopy for Patients with Ureteral Calculi and Normal Renal Function Who Present to the Emergency Department

Abstract: In our experience, emergency ureteroscopy showed equal efficacy and safety compared with the elective procedure. It has the main advantage of providing both immediate relief from pain and stone fragmentation.

Cited by 40 publications

References 24 publications

Emergency versus elective ureteroscopic treatment of ureteral stones

Emergency versus elective ureteroscopic treatment of ureteral stones

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

Is it Feasible and Cost-Effective to Perform Emergency Ureteroscopic Treatment for Acute Ureteric Colic?

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