Sunday June 30, 2019 from 07:30 to 09:00
Success rate of repeat flexible ureteroscopy following previous failed access from ureteral spasm
Dylan Hoare1, Tim Wollin1, Shubha De1, Michael G. Hobart1.
1Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
Introduction: Approximately 8% of patients that undergo therapeutic or diagnostic ureteroscopy will have the procedure aborted due to failed access. These patients are usually stented to allow for passive dilation of the ureter. There is currently no evidence-based duration for indwelling ureteric stents after which interval ureteroscopy should be attempted. The primary objective of this study was to assess the average time to salvage/staged ureteroscopy and the associated rate of successful renal access.
Methods: This retrospective descriptive study evaluated all patients undergoing interval ureteroscopy following a failed procedure by urologic surgeons participating in the stone treatment group at the University of Alberta affiliated hospitals. Patients were identified from January 2016 to March 2018 with billing codes signifying “diagnostic ureteroscopy." These patients were then individually queried and those with failed access were included in our patient cohort. Patients declining interval ureteroscopy or those with known strictures were excluded. The outcome measures were mean/median time to salvage ureteroscopy (days) and the rate of successful renal access of the repeat procedure.
Results: A total of 119 patients were identified as having a failed ureteroscopy during our study period. Average and median age were 55.85 and 56.99 years, respectively. Median stent duration to second procedure was 17 days (mean 20.46, range 10–84). Twenty-two (18.49%) patients had their repeat ureteroscopy between 10 and 13 days. No patients underwent repeat ureteroscopy in less than 10 days. The overall success rate of renal access during a second ureteroscopy after stenting was 99.16% (118/119).
Conclusions: Ureteric stenting following failed ureteroscopy leads to exceedingly high rates of successful access at interval procedure (99.16%). Of the patients that underwent an accelerated second procedure (between 10 and 13 days of stenting), all had successful access at their interval procedure.