MP51-09 PRIMARY VERSUS DEFERRED URETEROSCOPY FOR MANAGEMENT OF CALCULUS ANURIA: A PROSPECTIVE RANDOMIZED TRIAL

INTRODUCTION AND OBJECTIVES: The role of ureteroscopy (URS) in management of acute renal failure caused by ureteral calculi could be primary or deferred after ureteral stenting. In this study we evaluate both approaches as regards the feasibility and clinical outcome. METHODS: Between January 2012 and December 2014, 150 patients with anuria / oliguria with a significant increase in serum creatinine due to ureteral stones (114 men and 36 women); including 72 solitary functioning kidney. Patients were prospectively randomized according to timing of ureteroscopic intervention into two groups; deferred URS group (69 patients who were treated initially by ureteral stenting then URS in another session) and primary URS group (81 patients who were treated by emergency URS). Follow up was at least 6 months postoperatively. RESULTS: Stone distribution was: 56% lower ureteral, 32% mid ureteral, and 12% upper ureteral. Both groups were comparable at presentation. Complete ureteroscopic stone clearance was 87 % and 75.3% for deferred and primary URS groups respectively (p1⁄40.097). Normal renal function returned in 94.2% of deferred URS vs. 97.5% of primary URS (p1⁄40.414). Deferred URS group had 2.9 % overall complication rate in comparison to 9.9 % for primary URS group (p1⁄40.109). Ureteral perforation/pyelonephritis was noted in 6.2% of primary URS group only (p1⁄40.043). Median number of maneuvers required till stone clearance was one (range 1-5) for primary URS vs. two (range 2-3) for deferred URS (p u003c 0.001). The cost of primary URS was significantly lower (p u003c 0.001). On multivariate analysis, lower ureteral calculi (OR 13.03, 95% CI 4.0741.7, pu003c0.001) and deferred URS (OR 2.84, 95% CI 1.077.49, p1⁄40.035) were independent predictors for eventless successful URS. CONCLUSIONS: Deferred URS is still the standard treatment for calculus anuria. Primary URS is feasible but technically demanding and has higher complication rate especially for middle/upper ureteral calculus anuria.