Presentation Authors: Alexander Parker*, Bryan Pham, Joel Vetter, Ramakrishna Venkatesh, Alana Desai, St. Louis, MO
Introduction: Ureteroscopy (URS) for stone extraction often requires more than one visit to the operating room due to inability to access the renal pelvis. We sought to identify the risk factors for failed ureteroscopic access.
Methods: In this retrospective study from a tertiary university hospital, we examined the risk factors for failed ureteroscopic access in 182 consecutive patients. Failed access was defined as the inability to traverse the complete ureter and visualize the entire renal pelvis. Risk factors evaluated included sex, race, age, BMI, history of urinary tract infection, prior stone procedure, stone laterality, aspirin use, pre-operative urine culture, preoperative antibiotics, Charlson comorbidity, history of prior stent, preoperative stent, as well as dwell time, operative time and total stone burden (mm). Fisherâ€™s exact test and Wilcoxon rank-sum test were used to test for associations between failed URS access and patient-related and surgical factors.
Results: Of the 182 attempts at URS, failure to obtain access occurred in 10 instances. In those cases of failed access, there were no patients that had a preoperative stent placed prior to the procedure (p=0.006), and were less likely to have ever had a stent previously (20.0% vs. 54.1%, p=0.0499). In 70% of failed access, stones were lateralized to the left and the other 30% were bilateral stones (p=0.017) and the mean operative time was significantly shorter (32.9 vs. 70.1 minutes, p=0.002). The failed access group were more likely to have stent dwell time of >14 days following procedure (30.2% vs. 80.0%, p=0.010).
Conclusions: The majority of the patients with failed access had no history of stent placement. None of the patients in our cohort who experienced failed ureteroscopic access had a preoperative stent prior to surgery. In addition, 80% of patients had a post-operative stent dwell time >14 days, which could provide valuable data when determining adequate length of time for passive dilation to occur prior to stone removal.