Predicting negative ureteroscopy for stone disease - Minimizing risk and cost

Area of Science:

• Urology
• Medical Diagnostics
• Health Services Research

Background:

• Urolithiasis, particularly ureteric stones, is a global health concern.
• Ureteroscopy (URS) is a common treatment for ureteric stones, but carries a 4% complication risk.
• Negative URS, occurring in up to 15% of cases, leads to avoidable patient risk and resource utilization.

Purpose of the Study:

• To determine the incidence of negative URS.
• To identify factors predicting negative URS outcomes.
• To propose strategies for minimizing unnecessary URS procedures and their associated costs.

Main Methods:

• A retrospective cohort study analyzed 262 patients undergoing URS for ureteric stones over two years.
• Data collected included patient demographics, comorbidities, and laboratory and imaging findings.
• Logistic regression analysis was employed to identify significant predictors of negative URS.

Main Results:

• The study found a high rate of negative URS at 29.8% (78 out of 262 patients).
• Negative URS was more prevalent in female patients, and associated with primary, smaller, and radiolucent stones.
• Multivariate analysis identified smaller stone size and radiolucency as significant predictors of negative URS, with a classification accuracy of 76%.

Conclusions:

• The observed negative URS rate in this center exceeds typical literature values.
• Female patients and those with small, radiolucent stones exhibit higher rates of negative URS.
• These findings suggest potential for improved patient selection and resource allocation to reduce unnecessary URS procedures.