Mp75-12 prospective evaluation of stone free rates by computed tomography after aggressive ureteroscopy

You have accessJournal of UrologyStone Disease: Surgical Therapy VII1 Apr 2017MP75-12 PROSPECTIVE EVALUATION OF STONE FREE RATES BY COMPUTED TOMOGRAPHY AFTER AGGRESSIVE URETEROSCOPY Noah Canvasser, Aaron Lay, Elysha Kolitz, Jodi Antonelli, and Margaret Pearle Noah CanvasserNoah Canvasser More articles by this author , Aaron LayAaron Lay More articles by this author , Elysha KolitzElysha Kolitz More articles by this author , Jodi AntonelliJodi Antonelli More articles by this author , and Margaret PearleMargaret Pearle More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2160AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous retrospective and prospective studies have shown surprisingly low stone free rates (SFR) (approximately 50%) after ureteroscopy (URS) using stringent computed tomography (CT) criteria, although the aggressiveness of fragment extraction was not always quantified. Our goal was to determine SFR by CT after URS and aggressive fragment retrieval, quantified by the number of ureteroscope passes through a ureteral access sheath (UAS). METHODS We prospectively evaluated patients undergoing URS with laser lithotripsy at our institution from December 2015 to October 2016. UAS were used in all patients except those with distal ureteral stones. Every attempt was made to extract all stone fragments, regardless of size, after fragmentation. Patient demographics, stone number, size, and location, and the number of passes of the ureteroscope were recorded. SFR was determined using non-contrast CT scan approximately 8 weeks after the procedure. Stone free (SF) cohort was compared to the residual fragment (RF) cohort using the student′s T-test and the chi-squared test, and binary logistic regression identified factors associated with stone free status. Statistical significance was set at p < 0.05. RESULTS In total, 104 patients (141 renal units) underwent URS, with 67 patients (84 renal units) completing radiographic follow up to date. Mean number of stones was 3.3 and mean aggregate stone size was 13mm. Our overall SFR was 55%, with a mean number of ureteroscope passes of 44 (range 1 - 164). On univariate comparison between the SF and RF cohorts, SF patients had fewer numbers of stones (2.4 vs. 4.3, p=0.001), smaller aggregate stone size (11 vs. 15mm, p=0.02), and a smaller proportion of renal or renal and ureteral stones (54% and 15% vs. 66% and 26%, respectively, p=0.003). There were no significant differences in OR time, UAS size, or the number of ureteroscope passes (41 vs. 48, p=0.4) between groups. Binary logistic regression revealed no significant factors predictive of SF status. CONCLUSIONS SFRs by CT after URS are disappointingly low even with aggressive manual fragment retrieval. Larger sample size is likely to identify select cohorts of patients that benefit most from URS. © 2017FiguresReferencesRelatedDetailsCited bySorensen M (2019) Editorial CommentaryUrology Practice, VOL. 6, NO. 5, (298-298), Online publication date: 1-Sep-2019. Volume 197Issue 4SApril 2017Page: e1007-e1008 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Noah Canvasser More articles by this author Aaron Lay More articles by this author Elysha Kolitz More articles by this author Jodi Antonelli More articles by this author Margaret Pearle More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...