Is pre-operative imaging essential prior to ureteric stone surgery?

Area of Science:

• Urology
• Medical Imaging
• Nephrology

Background:

• Urolithiasis management often involves surgical intervention like semirigid ureteroscopy (R-URS).
• Pre-operative imaging is crucial for surgical planning in patients with ureteric stones.

Purpose of the Study:

• To identify patients with urolithiasis who do not require ureteric stone surgery.
• To evaluate the utility of pre-operative imaging (within 24 hours) before R-URS.

Main Methods:

• Retrospective review of imaging for 96 consecutive patients undergoing R-URS for urolithiasis.
• Imaging modalities included plain x-ray of the kidney, ureters and bladder (KUB) and/or abdominal non-contrast computed tomography (NCCT-KUB) on the day of surgery.

Main Results:

• 13% (14/96) of patients were cancelled due to absence of stones on pre-operative imaging.
• Spontaneous stone passage was confirmed by NCCT-KUB in 62% (8/13) of cancelled patients.
• Stone sizes in the study cohort ranged from 3 mm to 20 mm.

Conclusions:

• Approximately one in seven patients undergoing elective ureteric stone surgery were found to be stone-free on the day of the procedure.
• Pre-operative imaging can prevent unnecessary anesthesia and instrumentation, reducing patient morbidity.
• Up-to-date imaging prior to elective ureteric stone surgery is strongly recommended.