Ureterorenoscopic stone procedures have low success rates and poor post-operative follow-up: results from an Australian tertiary health service.
Australia
complications
imaging
ureterorenoscopy
urinary tract stones
Journal
ANZ journal of surgery
ISSN: 1445-2197
Titre abrégé: ANZ J Surg
Pays: Australia
ID NLM: 101086634
Informations de publication
Date de publication:
12 Apr 2023
12 Apr 2023
Historique:
revised:
11
03
2023
received:
21
07
2021
accepted:
28
03
2023
entrez:
12
4
2023
pubmed:
13
4
2023
medline:
13
4
2023
Statut:
aheadofprint
Résumé
To assess the results of ureterorenoscopy (URS) for upper tract urolithiasis in a contemporary Australian tertiary healthcare setting. Hospital records of all URS stone procedures performed between January 2017 and December 2018 in a metropolitan service were retrospectively reviewed. Outcome measures including stone free rates, adherence to postoperative follow-up and complications rates were recorded. 385 patients (387 renal units) with mean age 53.8 (range 18-89) underwent URS for stones measuring between 2 and 27 mm (median 8 mm). 465 URS were performed with 1029 total procedures performed. 48.6% of operations were performed as day cases. Complications were recorded in 9% of the 465 URS cases with 42.9% of these Clavien II or more. The representation rate to our Emergency Departments was 15.4%. Only 49.1% (201) of patients had a follow-up review with imaging to assess stone free rates. Of the 201 patients who underwent imaging, only 38.3% were stone free. Stone analysis was performed in 34.5%. Less than half of all patients were reviewed despite undergoing expensive, time consuming surgery for a condition with a high recurrence rate. In agreement with recent publications stone-free rates were low, with significant complications and representation rates. Stone surgery should be given the attention and resources equivalent to cancer surgery to improve results. 2b.
Sections du résumé
BACKGROUND
BACKGROUND
To assess the results of ureterorenoscopy (URS) for upper tract urolithiasis in a contemporary Australian tertiary healthcare setting.
METHODS
METHODS
Hospital records of all URS stone procedures performed between January 2017 and December 2018 in a metropolitan service were retrospectively reviewed. Outcome measures including stone free rates, adherence to postoperative follow-up and complications rates were recorded.
RESULTS
RESULTS
385 patients (387 renal units) with mean age 53.8 (range 18-89) underwent URS for stones measuring between 2 and 27 mm (median 8 mm). 465 URS were performed with 1029 total procedures performed. 48.6% of operations were performed as day cases. Complications were recorded in 9% of the 465 URS cases with 42.9% of these Clavien II or more. The representation rate to our Emergency Departments was 15.4%. Only 49.1% (201) of patients had a follow-up review with imaging to assess stone free rates. Of the 201 patients who underwent imaging, only 38.3% were stone free. Stone analysis was performed in 34.5%.
CONCLUSION
CONCLUSIONS
Less than half of all patients were reviewed despite undergoing expensive, time consuming surgery for a condition with a high recurrence rate. In agreement with recent publications stone-free rates were low, with significant complications and representation rates. Stone surgery should be given the attention and resources equivalent to cancer surgery to improve results.
LEVEL OF EVIDENCE
METHODS
2b.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.
Références
Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan Y. Epidemiology of stone disease across the world. World J. Urol. 2017; 35: 1301-20.
Türk C, Petřík A, Sarica K et al. EAU guidelines on interventional treatment for urolithiasis. Eur. Urol. 2016; 69: 475-82.
Wendt-Nordahl G, Mut T, Krombach P, Michel MS, Knoll T. Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors? Urol. Res. 2011; 39: 185-8.
Santiago JE, Hollander AB, Soni SD, Link RE, Mayer WA. To dust or not to dust: a systematic review of ureteroscopic laser lithotripsy techniques. Curr. Urol. Rep. 2017; 18: 32.
Perera M, Papa N, Kinnear N et al. Urolithiasis treatment in Australia: the age of ureteroscopic intervention. J. Endourol. 2016; 30: 1194-9.
Humphreys MR, Shah OD, Monga M et al. Dusting versus basketing during ureteroscopy-which technique is more efficacious? A prospective multicenter trial from the EDGE research consortium. J. Urol. 2018; 199: 1272-6.
Suarez-Ibarrola R, Hein S, Miernik A. Residual stone fragments: clinical implications and technological innovations. Curr. Opin. Urol. 2019; 29: 129-34.
Ahn JS, Holt SK, May PC, Harper JD. National imaging trends after ureteroscopic or shock wave lithotripsy for nephrolithiasis. J. Urol. 2018; 199: 500-7.
Srisubat A, Potisat S, Lojanapiwat B, Setthawong V, Laopaiboon M. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst. Rev. 2014; 24: CD007044. doi:10.1002/14651858
Lee M-C, Bariol SV. Evolution of stone management in Australia. BJU Int. 2011; 108: 29-33.
York NE, Zheng M, Elmansy HM, Rivera ME, Krambeck AE, Lingeman JE. Stone-free outcomes of flexible ureteroscopy for renal calculi utilizing computed tomography imaging. Urology 2019; 124: 52-6.
Pearle MS. Is ureteroscopy as good as we think? J. Urol. 2016; 195: 823-4.
Yecies TS, Semins MJ. Modeling the incidence of secondary malignancy related to ionizing radiation use in the management of nephrolithiasis. Urology 2019; 130: 48-53.
Lockhart KR, McIlwain E, David G, Raman A. Urosepsis and fever after laser lithotripsy procedures in a single Australian institution. J. Clin. Urol. 2020; 13: 343-8.
Buldu I, Tepeler A, Karatag T et al. Which factors affect the hospital re-admission and re-hospitalization after flexible ureterorenoscopy for kidney stone? World J. Urol. 2016; 34: 1291-5.
Galiabovitch E, Hansen D, Retegan C, McCahy P. Urinary tract stone deaths: data from the Australian and New Zealand audits of surgical mortality. BJU Int. 2020; 126: 604-9.
Specchia ML, Frisicale EM, Carini E et al. The impact of tumor board on cancer care: evidence from an umbrella review. BMC Health Serv. Res. 2020; 20: 73.
NICE. Guideline-renal and ureteric stones: assessment and management: NICE (2019) renal and ureteric stones: assessment and management. BJU Int. 2019; 123: 220-32.
Constanti M, Calvert RC, Thomas K, Dickinson A, Carlisle S. Cost analysis of ureteroscopy (URS) vs extracorporeal shockwave lithotripsy (ESWL) in the management of ureteric stones <10 mm in adults: a UK perspective. BJU Int. 2020; 125: 457-66.