Category: Epidemiology, Health Policy, Socioeconomics & Outcomes

MP28-18 - Delays in Emergency Urological Stent Insertions – Case for an Emergency Pathway for Obstructing Stones

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective :

Obstructing renal stones are a common reason for attendance in emergency departments, and for acute hospital admission. A small cohort of these patients are acutely unwell, septic and need urgent drainage within several hours of admission with either a retrograde JJ stent or a nephrostomy. However the majority do not need such urgent intervention but for reasons such as pain, or deranged renal function need expedited drainage with a JJ stent or primary ureteroscopy. These patients often end up waiting several days for their procedure due to their lower priority on the emergency theatre booking. This causes them to experience pain for longer, potentially further renal injury, a poorer patient experience and higher hospital costs and bed blocking.

We aimed to review the number of emergency JJ stents done over 3 months, and to identify the time from admission of patients till the time of JJ stenting to identify delays stent insertion.


Methods :

We reviewed all patients who had an emergency retrograde JJ stent insertion between 1/11/2017-31/1/2018. Data included time taken to stent insertion as well as stone size. Patients excluded were those that had stents inserted for other causes of obstruction e.g. tumours, PUJ obstruction, and patients that had a primary ureteroscopy.


Results :

Between November 2017 and January 2018, 51 patients had emergency stents inserted for obstructing stones. The average age was 48 (range 20-84, SD±15). The average time taken for stent insertion from admission was: 1.53 days (range 0-4, SD±0.92) (figure 1). The average stone size 7.0mm (range 3-12mm, SD±2.2). The proportion of stone locations is shown in figure 2.


Conclusions :

Delays in waiting for JJ stents cause significant cost to the NHS and increased bed burden. An emergency stent pathway may help to reduce cost and free beds, and provide patients with a better service. A potential algorithm that we are attempting to implement at our institution is shown in figure 3.

Masood Moghul

Urology Registrar
Royal Free Hospital NHS Trust
st albans, England, United Kingdom

Masood Moghul MRCS, PgDip, MBBS, BSc (Hons.), AKC
Urology SpR, London

John Withington

Urology Registrar
Royal Free Hospital NHS Trust
London, England, United Kingdom

Anuj Goyal

Consultant Urologist
Royal Free Hospital NHS Trust
London, England, United Kingdom

Rajesh Kucheria

Darrell Allen

Consultant Urologist
Royal Free Hospital NHS Trust
London, England, United Kingdom

Leye Ajayi

Consultant Urologist
Royal Free Hospital NHS Trust
London, England, United Kingdom