Emergency Primary Ureteroscopy for Acute Ureteric Colic-From Guidelines to Practice
Yasmin Abu-Ghanem1, Christina Fontaine1, Radha Sehgal1
1Department of Urology, Royal Free London NHS Foundation Trust, London NW3 2QG, UK.
Journal of Personalized Medicine
|December 29, 2022
Summary
In a tertiary center, not all kidney stone patients receive immediate definitive treatment due to factors like stone size and location. Emergency stenting offers a safe alternative for symptomatic renal colic when definitive care is delayed.
Area of Science:
- Urology
- Nephrology
- Surgical Management
Background:
- Current National Institute for Health and Care Excellence (NICE) guidelines recommend definitive treatment for symptomatic renal colic within 48 hours if spontaneous passage is unlikely.
- Tertiary centers face challenges in consistently applying these guidelines due to various influencing factors.
Purpose of the Study:
- To review factors affecting the feasibility of providing guideline-recommended definitive treatment for renal colic in a well-resourced tertiary center.
- To compare outcomes between primary definitive surgery and primary symptom relief via urethral stenting.
Main Methods:
- Retrospective review of 244 patients with ureteric or renal stones presenting to the emergency department (January-December 2019).
- Comparison of emergency intervention rates, risk factors, and outcomes between primary definitive surgery (ureteroscopy or ESWL) and primary stenting.
Main Results:
- Only 37.7% of patients received primary definitive treatment (ureteroscopy or ESWL); the mean time to procedure was 25.5 hours.
- Patients receiving definitive treatment were more likely to have smaller, distal stones.
- Primary ureteroscopy was more often performed under supervision compared to emergency stenting.
Conclusions:
- Definitive treatment for kidney stones has high success rates but may not be feasible for all patients in high-volume tertiary centers.
- Emergency stenting serves as a safe and effective interim measure.
- Stone location, stone size, and resident supervision are key factors influencing the ability to offer definitive treatment promptly.
Related Concept Videos
01:28Urinary Tract Calculi V: Nursing Management
20
AssessmentSubjective Data: Obtain a detailed health history, including any recent or chronic urinary tract infections, periods of immobilization, previous episodes of renal calculi, and medical conditions such as gout, benign prostatic hyperplasia, or hyperparathyroidism. Review the medication history for drugs that may influence stone formation, including allopurinol, analgesics, loop diuretics, or thiazide diuretics. Document the use of long-term indwelling catheters and any past surgical...
20
01:28Urologic Endoscopic Procedure: Cystoscopic Examination
208
Meaning of Cystoscopic Examination:Cystoscopy is an essential diagnostic tool in urology that is used to assess the structure and function of the genitourinary system. It provides a direct view of the urethra, bladder, and, in some cases, the ureteral openings. This procedure helps detect structural abnormalities, infections, cancers, and blockages in the urinary tract. There are two types of cystoscopy:Flexible cystoscopy is commonly performed in outpatient settings due to its less invasive...
208
01:22Imaging Studies V: Intravenous Urography and Retrograde Pyelography
111
IntroductionIntravenous Urography (IVU) and Retrograde Pyelography (RP) are important diagnostic imaging techniques used to evaluate the urinary system. These methods help identify structural abnormalities, obstructions, and functional issues in the kidneys, ureters, and bladder. Both procedures use iodine-based contrast media to enhance the visibility of urinary tract structures on X-ray images, though they differ in their methods and indications.1. Intravenous Urography (IVU)Intravenous...
111
01:25Urinary Tract Calculi VI: Surgical Management
19
Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
19
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
28
Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
28
01:30Urinary Tract Calculi III: Medical Management
13
The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
13