Unplanned Emergency Department Visits and Hospital Admissions Following Ureteroscopy: Do Ureteral Stents Make a Difference?

Mittakanti, Harsha R.; Conti, Simon; Pao, Alan C.; Chertow, Glenn M.; Liao, Joseph C.; Leppert, John T.; Elliott, Christopher S.

doi:10.1016/j.urology.2018.03.019

Cited by 31 publications

(25 citation statements)

References 19 publications

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“…7,8,10 Specifically, unanticipated visits after ureteroscopy for stone disease has been reported to be 6.6%, and the majority of these visits are made due to pain. 5,11 An important finding of our study is that most patients before stone surgery have had opiate exposure within the previous 30 days, and a significant proportion have had multiple prescriptions. This highlights a fundamental challenge of addressing how and when opiates are prescribed to kidney stone patients as they often encounter multiple providers across different settings.…”

Section: Discussionmentioning

confidence: 79%

“…4 These patients often have had multiple encounters with providers for symptom relief before intervention, 4 and after intervention may have symptoms related to the procedure or ureteral stenting. 5 A prior study of opioid dependence and overdose after urologic procedures identified younger age, inpatient surgery, longer length of stay, noninsured or Medicare/Medicaid insurance status, and several comorbidities as risk factors. 4 Specifically, the incidence after stone surgery was 0.15% within 1 year.…”

Section: Introductionmentioning

confidence: 99%

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Opiate Exposure and Predictors of Increased Opiate Use After Ureteroscopy

Kang

Shu

Herrell

et al. 2019

Journal of Endourology

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Objective: Kidney stone formers are at risk for opioid dependence. The aim of this study is to describe opiate exposure and determine predictors of prolonged opiate use among kidney stone formers after surgery. Materials and Methods: A retrospective review was performed among patients who underwent ureteroscopy for upper tract stone disease. Prescription data were ascertained from a statewide prescribing database. Demographic data and surgical factors were collected from the electronic medical record. Predictors of additional postsurgery prescriptions filled within 30 days and persistent opiate use 60 days after ureteroscopy were determined. Results: Among 208 patients, 127 (61%) had received preoperative opiate prescriptions within 30 days before surgery. Overall, 12% (n = 25) of patients required an additional opiate prescription within 30 days after ureteroscopy, and 7% (n = 14) of patients continued to use opiate medications more than 60 days postoperatively. Patients continuing to use opiates long-term were not chronic opiate users. For both outcomes, preoperative opiate exposure, including number of prescriptions, days prescribed, and unique providers had significant associations (all p < 0.05). Additionally, younger age (p = 0.049) was associated with obtaining an additional opiate prescription within 30 days. Lower BMI (p = 0.02) and higher ASA score (p = 0.03) were predictors of continued opiate use more than 60 days after ureteroscopy. Conclusions: The majority of stone formers have had opiate exposure before surgery, often from multiple providers. Approximately 1 in 8 stone formers who undergo ureteroscopy require additional opiate prescriptions within 30 days. A small but significant population receive opiates beyond the immediate postoperative period.

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Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Opiate Exposure and Predictors of Increased Opiate Use After Ureteroscopy

Kang

Shu

Herrell

et al. 2019

Journal of Endourology

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“…Ureteral stenting with a double‐J stent is usually practiced after URS or RIRS, especially when UAS is used. It is believed that its use will decrease postoperative complications, and stents will be removed in 3–14 days to minimize the complications . However, forgotten stents is an important issue, with a report rate of up to 12.5% .…”

Section: Ureteroscopy and Retrograde Intrarenal Surgerymentioning

confidence: 99%

“…It is believed that its use will decrease postoperative complications, 167 and stents will be removed in 3-14 days to minimize the complications. [168][169][170] However, forgotten stents is an important issue, with a report rate of up to 12.5%. 171 Two important ways to reduce the incidence is to increase the patient's awareness about the presence of the stent and have proper documentation.…”

Section: Complicationsmentioning

confidence: 99%

Updates in endourological management of urolithiasis

Teoh

2018

Int J of Urology

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Urinary stone disease, or urolithiasis, is a very common disease with increasing prevalence and incidence. With the advancement of endoscopic techniques, the treatment outcomes of ureteroscopy (or transureteral lithotripsy) and percutaneous nephrolithotomy are continuously improving. In recent years, there have been many new developments in the field, including new endoscopy design, more effective auxiliary tools, improvement in treatment protocols, introduction of robotic technology, combining both ureteroscopy and percutaneous nephrolithotomy (endoscopic combined intrarenal surgery or transureteral lithotripsy‐assisted percutaneous nephrolithotomy), improvement in laser technology, and so on. All these new inputs will further improve the treatment efficacy and safety of the procedures, thus benefiting our patients. In the present review, we briefly go through the main steps of ureteroscopy and percutaneous nephrolithotomy, with a concise description and application of these new advances.

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“…European and USA guidelines currently do not recommend routine DJ stent insertion after URS 3 . However, a recently published observational study ( n = 17 129) from the USA showed that guidelines and clinical practice appear to differ: DJ stent insertion was carried out in 86.2% of patients undergoing laser lithotripsy and in 70.5% of patients undergoing basket retrieval 7 …”

Section: Introductionmentioning

confidence: 99%

Transient stent placement versus tubeless procedure after ureteroscopy retrograde surgery stone extraction (Fast Track Stent study 2): A randomized prospective evaluation

et al. 2020

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Objectives To determine whether in pre‐stented patients undergoing ureteroscopic stone removal (ureteroscopy retrograde surgery) a tubeless procedure provides a better outcome compared with short‐term (6 h) ureteral stenting using an external ureteral catheter. Methods In this single academic center study (Fast Track Stent study 2), carried out between May 2016 and April 2018, 121 patients with renal or ureteral calculi were initially treated with double‐J insertion. Before secondary ureteroscopy retrograde surgery, patients were prospectively randomized into two groups: tubeless versus ureteral catheter insertion for 6 h after ureteroscopy retrograde surgery. Exclusion criteria were acute urinary tract infection, solitary kidney or stone diameter >25 mm. Study end‐points were stent‐related symptoms assessed by a validated questionnaire (ureteral stent symptom questionnaire), administered both before and 4 weeks after surgery. Numerical ureteral stent symptom questionnaire scores were compared using the Mann–Whitney‐U‐test. The level of significance was defined as P < 0.05. Results Ureteroscopy retrograde surgery procedures carried out by 13 surgeons resulted in >90% stone removal in all patients (n = 121), with a mean operation time of 19.9 versus 18.0 min for ureteral catheter versus tubeless, respectively (P = 0.37). Patient groups did not differ significantly in their ureteral stent symptom questionnaire scores (urinary index P = 0.24; pain index P = 0.35). Patients showed a significant preference for tubeless procedure over ureteral catheter reinsertion (Question GQ P < 0.0001). The reintervention rate was 13.3% for the tubeless procedure (n = 8) and 1.6% for the ureteral catheter group (n = 1), respectively (P = 0.034). Conclusions Short‐term ureteral catheter and no stent insertion after ureteroscopy retrograde surgery stone extraction in pre‐stented patients result in comparable quality of life. However, the reintervention rate is higher for tubeless procedures.

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Unplanned Emergency Department Visits and Hospital Admissions Following Ureteroscopy: Do Ureteral Stents Make a Difference?

Cited by 31 publications

References 19 publications

Opiate Exposure and Predictors of Increased Opiate Use After Ureteroscopy

Opiate Exposure and Predictors of Increased Opiate Use After Ureteroscopy

Updates in endourological management of urolithiasis

Transient stent placement versus tubeless procedure after ureteroscopy retrograde surgery stone extraction (Fast Track Stent study 2): A randomized prospective evaluation

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