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Introduction: Stone treatment is often deferred in favor of ureteral stenting amongst patients admitted with symptomatic ureterolithiasis due to concerns for higher complication rates and diminished efficacy. To this point, pre-operative factors that predict treatment success have not been reported. We sought to review our recent experience with emergency ureteroscopy (URS).
Materials & Methods: All patients that underwent inpatient URS for acute symptomatic ureterolithiasis from 2010 to 2014 were reviewed. Laboratory and radiographic data were analyzed. Statistical difference was assessed with Student’s t-test. DUST score was determined based upon the number of cutoff values a patient was below for rise in serum creatinine (∆Cr) and periureteral density (PUD).
Results: 58 of 73 patients (80%) were stone-free (SF). One complication (ureteral perforation) occurred. Stone size, duration of symptoms prior to presentation and serum WBC at presentation did not affect SF-rates. PUD was lower in SF-patients (3.25 vs. 23.3 HU, p = 0.013) while ∆Cr was greater in non-SF patients (0.43 vs. 0.24 mg/dL, p = 0.02). The SF-rate for PUD ≤ 5 HU was 100%, in comparison to 53% for PUD > 5. The SF-rate for ∆Cr < 0.3 was 93%, compared with 48% for ∆Cr ≥ 0.3. DUST score of 0, 1 and 2 correlated with SF-rates of 26%, 84% and 100%, respectively.
Conclusions: Emergency URS for ureterolithiasis appears to be a safe and effective procedure. Consideration of preoperative factors including periureteral density and rise in serum creatinine can assist in selecting optimal candidates for immediate endourological management.