Presentation Authors: Vigen Malkhasyan*, George Kasyan, Malika Dzhuraeva, Igor Semenyakin, Dmitriy Pushkar, Vadim Ivanov, Moscow, Russian Federation
Introduction: Renal colic caused by urinary stones is one of the most common emergencies in urology. During the last few decades, the number of patient admissions with renal colic has grown dramatically. The first line of therapy for patients with renal colic is appropriate pain relief. If pain management cannot be achieved through medication, decompression of the renal collecting system using percutaneous nephrostomy or a ureteric stent is indicated . In this case, emergency ureteroscopy and shock wave lithotripsy (SWL) might be a feasible option for patients because it allows for proper analgesia and renders the patient stone free. There is a growing number of publications in the literature outlining the safety and efficacy of emergency ureteroscopy. However, it is still unclear which cases require the use of emergency ureteroscopy. In this study, we report our experience with emergency ureteroscopy compared to elective surgery in patients with renal colic.
Methods: We performed a retrospective analysis of 4021 records of renal colic patients admitted into our clinic who subsequently underwent ureteroscopy from 2001 to 2014. Patients were divided into 2 groups. Group A was composed of 838 (20.5%) patients who underwent ureteroscopy in the first 24 hours after admission (the emergency ureteroscopy group). The second group was composed of 3193 (79.5%) patients who underwent ureteroscopy electively after readmission (group B, or the elective ureteroscopy group).
Results: Median stone size did not differ significantly between groups (7.79Â±2.88 mm vs 7.71Â±2.92) (Ñ€=0.03). No statistically significant differences in efficacy or complication rates were identified between the two groups. Stone fragmentation and relief of obstruction was observed in 740 (88.3%) cases in group A and in 2943 (89.0%) patients in group B (p=0.58). Ureteroscopy failed in 3.3% of the cases in group A and 4.9% of cases in group B. Proximal migration of the stone was observed in 32 (4,3%) patients in group A and 89 (3,02%) patients in group B. The overall complication rates were 7.3% and 7.7% in the emergency ureteroscopy and elective ureteroscopy groups, respectively (p=0.976). Ureteric stenting was more common in the emergency ureteroscopy group (79.9% vs 73.5%, p < 0.001). The median hospital stay was shorter in the emergency ureteroscopy group than in the elective group (5 vs 7 days, p < 0,001). Grade 2-3 ureteral wall injury was observed in 0.5% of patients in group A and in 0.4% of patients in group B. Both groups had a 0.1% rate of avulsion of the ureter. Postoperative fever was observed in 6.4% of patients in group A and in 7.2% of patients in group B.
Conclusions: Emergency ureteroscopy is an efficient and safe option for patients with renal colic. The method provides appropriate pain relief and renders the patient stone free. Nevertheless, further randomized studies are needed to recommend this method as a standard of care.