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MAAUA 68th Annual Meeting Abstracts
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Is Routine Imaging Following Ureteroscopy for Urinary Calculi Necessary?
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: Routine imaging to assess for obstruction or delayed excretion following URS procedures is debatable. We attempt to identify the variables associated with post-procedural abnormal imaging.
Materials & Methods: 478 patients underwent URS for renal/ureteral calculi from 2007 to 2009 at two medical centers. 332 of these patients were imaged with a CT scan (186), IVP (84), renal ultrasound (58), or diuretic renogram (4) within 4 months of URS. Abnormal imaging was defined as ipsilateral hydronephrosis (any grade) or evidence of delayed renal excretion.
Results: 59% of patients had previous stone surgery. Mean diameter of the target stone was 7.2mm with location being 28% kidney, 51% ureter, and 21% both. 56 of 332 (17%) patients had abnormal post-URS imaging with 50% being asymptomatic. Causes included stricture disease in 10 patients, obstructing residual stone fragments in 16, and delayed excretion without obvious stricture in 30. On univariate analysis, a prior ureteroscopic procedure (p=0.03) and inability to retrieve the target stone (p=0.007) were associated with abnormal imaging. However, age, gender, BMI, stone location, stone size, preoperative hydronephrosis, operative time, need for dilation/sheaths, duration of postoperative stenting, and stone composition were not. On multivariate analysis, a prior URS (OR 3.0, 95% CI 1.2-7.1, p=0.015) and inability to retrieve the stone (OR 3.4, 95% CI 1.3-9.1, p=0.013) independently predicted abnormal imaging.
Conclusions: 17% of patients undergoing URS had evidence of abnormal postoperative imaging. Prior URS or inability to retrieve the stone yielded an over three-fold increased incidence of abnormal imaging.
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