NEAUA Main Site   | Past & Future Meetings
The New England Section of the American Urological Association
Meeting
Home
Accreditation
Information
Preliminary
Program
Registration
Information
Housing
Information
Exhibitors &
Sponsors
Local Area
Attractions

Back to 2016 Annual Meeting


Periureteral Density and Change in SerumCreatinine Predict Emergency Ureteroscopy Outcomes in Patients with AcuteSymptomatic Ureterolithiaisis
Timothy Tran, MD, Gyan Pareek, MD.
Brown University, Providence, RI, USA.

BACKGROUND: Patients that present to the emergency department with intractable symptoms from acute ureterolithiasis are admitted and administered a trial of medical expulsive therapy (MET). Failure of MET prompts surgical intervention. Definitive stone treatment is oftentimes deferred owing to concerns for diminished treatment efficacy and and higher complication rates in the setting of acute ureteral inflammation. Pre-operative factors that may predict treatment success have not been clearly defined. We review our recent multi-institutional experience with emergency ureteroscopy (URS). METHODS: : A retrospective review was performed of all patients that underwent inpatient URS from 2010 to 2015. Inclusion criteria were presentation to the Emergency Department with acute renal colic, age > 18, non-contrast CT (NCCT) with ureteral stone and no evidence of sepsis. Laboratory and radiographic data were analyzed. Statistical difference was assessed with Student’s t-test. RESULTS: 187 of 223 patients (83.8%) were stone free. Two patients (0.8%) had an intraoperative complication (both with extravasation on retrograde pyelogram). Periureteral density (PUD) and rise in serum creatinine (ΔCr) were statistically different between patients that were stone-free and those that were not (1.2 versus 19.9 HU, p < 0.01 and 0.20 versus 0.56 mg/dL, p < 0.01, respectively). Patients that received an alpha-blocker prior to surgery were more likely to have successful treatment (90% vs. 11%, p < 0.01). No difference in patient age, duration of pain prior to surgery, the number of visits to the emergency department or degree of leukocytosis was observed between those that were successfully treated and those that were not. Success rates were not different between surgeons with and without endourology fellowship training (84.7% vs. 83.2%, p = 0.59).
CONCLUSIONS: : URS in the setting of acute renal colic for symptomatic ureterolithiasis is safe and effective. Treatment success does not appear to require advanced endourology training. Consideration of PUD and ΔCr pre-operatively can facilitate identification of ideal candidates for definitive treatment.


Back to 2016 Annual Meeting


Old Port
Bay by Holiday Inn
Lighthouse
© 2019 New England Section of the American Urological Association. All Rights Reserved. Privacy Policy.
Banner photo courtesty of Holiday Inn By the Bay © InterContinental Hotels.