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MAAUA 68th Annual Meeting Abstracts
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Residual Fragments Following Ureteroscopic Management of Calculi: Incidence and Predictors
Thomas Clements1, W. Aaron Caraway1, *Yu Kuan Lin1, Carl Reese1, Lewis Harpster1, Jay Raman1, *Margaret S Pearle2, *Yair Lotan2
1Milton S. Hershey Medical Center, Hershey, PA;2UTSW, Dallas, TX
Introduction: Improvements in endoscopy have increased the use of ureteroscopy (URS) for managing urolithiasis. Patients may have residual stone fragments (RF) after the initial procedure. We attempt to define incidence and predictive factors.
Materials & Methods: 478 consecutive patients underwent URS for renal/ureteral calculi between April 2007 and May 2009 at two institutions. 223 patients were imaged with CT scan (n=151) or KUB/IVP (n=72) within 3 months post-procedure. RFs were defined as residual ipsilateral renal/ureteral stones > 2mm. Preoperative variables were analyzed for their impact on RFs.
Results: 108 men and 115 women with a mean age of 47.3 years and mean BMI of 30.9 were included. The mean pre-treatment stone diameter was 7.3mm with 27% of stones located in the kidney, 53% in the ureter, and 20% in both. 84 patients (38%) had RFs with a mean size of 4.8mm. On univariate analysis, stone location in the kidney (p<0.001), multiple calculi (p<0.001), increasing stone diameter (p=0.03), absence of hydronephrosis (p=0.04), and the need for flexible URS (p=0.02) predicted RFs. Patient age, gender, BMI, stone-bearing calyx, retrieval method, operative duration, and stone composition were not associated with RFs. On multivariate analysis, stone location in the kidney (odds ratio [OR] 2.2, p=0.01), pre-treatment stone diameter > 5mm (OR 2.1, p=0.03), and need for flexible URS (OR 1.9, p=0.03) independently predicted RFs.
Conclusions: Among patients undergoing URS for renal or ureteral calculi, 38% had RFs according to CT/KUB. Stone size, location, and need for flexible URS were all independently associated with RFs.
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