Presentation Authors: Giovanni Cacciamani, Luis Medina*, Isabella Fuchs, Alessandro Tafuri, Angelica Hernandez, Joseph Thum, Gerhard Fuchs, Los Angeles, CA
Introduction: To assess SToNEfecta (Successful Treatment iN Endurology) outcome differences between patients with single stones located in the ureter, treated with URS, versus patients with single renal stones, treated with RIRS.
Methods: After IRB approval was obtained (HS-17-00974), 483 patients who underwent URS/RIRS from January 2011 through November 2017 by a single experienced surgeon were identified. Patients with bilateral or multiple stones were excluded from the analysis. Patients who simultaneously accomplished a) stone free rate in one session, b) absence of major urinary tract infections (UTI), and c) absence mechanical urothelial injuries were considered successful according to the STONE-fecta criteria. A multivariable model was used to confirm predictors. A p < 0.05 was considered statistically significant.
Results: Globally, 243 patients met the inclusion criteria. Of which, 105 (43.5%) and 136 (56.4%) presented with a stone located in the ureter and the kidney, respectively. No differences were found in terms of perioperative characteristics and chemico-physical stone examination. Maximum diameter was found to be smaller in renal stones (1.0 vs 1.2 cm; p=0.04). Figure 1 depicts the overall aggregate SToNEfecta rate. In our cohort, patients presenting ureteral stones showed a higher SToNEfecta rate when compared to those presenting renal stones (84.8% vs 72.1%; p= 0.026). With regards to STONEfecta outcomes, single procedure stone free rates (87.6% vs 79.1%; p= 0.03), major UTI free rates (99.0% vs 96.3%; p= 0.236) and iatrogenic urothelial injurie rates (97.1% vs 95.5%; p= 0.735) were found. At the multivariable analysis, stone location was proved to be a predictor for SToNEfecta achievement, even controlling for impacted stone rate, UTI history and maximum and minimum diameter (OR: 2.763; p=0.008).
Conclusions: This is the first study to assess STOnEfecta achievement for ureteral versus renal stones. SToNEfecta was confirmed as a predictive model that incorporates crucial criteria in terms of outcome reporting after URS/RIRS. The predictive model can be used when counselling patients (outcome expectation, treatment plan/number of procedures, etc) and in procedure scheduling (predicting number of procedures and resources required).