Ureteroscopy Versus Double J Stenting in Emergency Treatment of Obstructive Lithiasis

Objective: Ureteroscopy (URS) is a commonly used procedure for the management of ureteral stones. While elective URS has been extensively studied, the literature on emergency URS remains limited. The aim of the present study is to evaluate the efficacy and safeness of URS performed in emergency settings and to determine the ideal candidates for this type of intervention. Methods:Patients who underwent URS for ureteral stones in a single healthcare unit, "Saint John" Emergency Clinical Hospital, Bucharest, Romania, were included in a retrospective investigation between April 2022 and March 2023. The study group was divided into two subgroups: group A (138 patients who underwent semirigid URS in an emergency setting) which was subdivided into group A1 (95 patients with stone on the distal ureter) and group A2 (43 patients with stone on the proximal ureter), and group B (151 patients who underwent a double J stent insertion). The success rate defined as stone fragmentation and resolution of renal obstruction, along with intraoperative and postoperative complications were assessed. A URS procedure was considered unsuccessful if either the instrument could not be passed to access the stone or it was deemed unsafe to perform the URS. In such cases, patients were managed by inserting a ureteric stent and scheduled for a subsequent procedure. Results:It could be observed that most complications occurred in emergency ureteroscopy on distal ureter (95 cases) and the most severe ones on proximal ureter (two cases - Clavien 4). Double J stenting provided a reduced number of complications (51 cases). It should be mentioned that patients with emergency semirigid ureteroscopy had more complications than those with double J stent for every group of BMI, while most of the complications were observed in the groups with the highest BMI. The success of the URS procedure was determined based on complete stone fragmentation and extraction, and it was of 91.3% for cases with emergency ureteroscopy. Conclusion:Patients who underwent URS for ureteral stones at a single facility, "Saint John" Emergency Clinical Hospital, Bucharest, Romania, were included in a retrospective investigation. The success rates and complication rates of emergency URS were comparable to those of elective URS, providing valuable insights for clinical decision-making.