Zain Kasmani, Ananda Kumar Dhanasekaran
Birmingham City Hospital, Birmingham, United Kingdom
Introduction: Obstructing urolithiasis should be cleared on the first attempt, minimising the need for multiple treatments and associated morbidity. Complete clearance primary ureteroscopy (P-URS) is paramount in the NHS, where elective lists cannot accommodate ‘stent-and-wait’ patients. This project aims to evaluate the efficiency of our modified stone treatment pathway - promoting P-URS
Methods: We conducted 3 audit cycles in the years 2018 to 2022 including all patients listed for emergency stone surgery. Extracted data included demographics, stone number, location and size, presence of sepsis and whether URS was done.
Results: P-URS increased from 7.4% to 62.7% in 4 years. The average waiting time for subsequent treatment in those who did not have P-URS was 135 days in 2020 and 95 days in 2022. In 2022, 81% of P-URS achieved first-attempt complete clearance with no complications or readmission, with the remainder achieving faster clearance times than stent-only patients. Stent-only insertion led to subsequent URS in > 95% of cases. Spontaneous stone passage after stenting occurred in only 3%. There was no significant difference in WCC, CRP, age, sex or stone distribution between the cycles or between P-URS and stent-only patients. In 2022, all non-septic, stent-only patients had proximal or PUJ stones where the named consultant was not a stone specialist.
Conclusions: A limited spontaneous stone passage in stented patients means P-URS is necessary. P-URS has a high clearance rate, is safe and reduces waiting times for almost certain subsequent surgery, benefiting both patients and the NHS. Proximal stones remain a challenge to P-URS.