Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep;104(8):588-593.
doi: 10.1308/rcsann.2021.0260. Epub 2022 Feb 8.

Reducing the rate of negative ureteroscopy: predictive factors and the role of preoperative imaging

A C Brodie  1 , T J Johnston  2 , P Lloyd  1 , L Hemsworth  1 , M Barabas  3 , S R Keoghane  1   4
Affiliations

Reducing the rate of negative ureteroscopy: predictive factors and the role of preoperative imaging

A C Brodie et al. Ann R Coll Surg Engl. 2022 Sep.

Abstract

Introduction: The aim of this study was to investigate factors that may predict a negative ureteroscopy (URS) performed for ureteric calculi in prestented patients and to assess preoperative imaging in reducing the rate of negative URS.

Methods: Data were collected on emergency stent placement for a ureteric calculus from April 2011 to February 2016 (Group A) and October 2016 to October 2019 (Group B). Data included patient demographics, indication for a stent, stone characteristics, baseline bloods, urine culture, readmission, negative URS rate and the use of pre-URS imaging. Multivariate logistic regression was used for statistical analysis.

Results: Of 257 patients who underwent emergency stent insertion, 251 underwent deferred URS for a ureteric calculus and 6 avoided URS due to pre-URS imaging. Indications for stent were pain (42%), sepsis (39%) and acute kidney injury (19%). Mean stone size was 7.8mm, mean stone density was 699 Hounsfield units (HU) and the stone locations were upper (62%), mid (13%) and lower ureter (25%). The overall negative URS rate was 12%. The negative URS rate was lower in patients with pre-URS imaging compared with those with none, 6% and 14%, respectively (OR=2.33, 95% CI: 0.69-7.56, p=0.2214). Logistic regression analysis indicated stone size as the only significant predictor of a negative URS, where the greater the size of the stone the less likely URS would be negative (β=0.75, 95% CI: 0.60-0.94 p=0.011).

Conclusions: Utilising pre-URS imaging can lead to a reduction in negative URS rate. Stone size <5mm appears to be the subgroup most likely to benefit from imaging.

Keywords: Ureteroscopy; Urolithiasis; Uroradiology.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram showing outcomes of patients with and without imaging prior to definitive ureteroscopy. URS = ureteroscopy; Positive URS = finding of ureteric calculi during ureteroscopy; Negative URS = No ureteric calculi found during ureteroscopy.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Türk C, Skolarikos A, Neisius Aet al. . EAU guidelines Urolithiasis. Eur Assoc Urol 2019. https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Urolithiasis-201...
    1. Rukin NJ, Siddiqui ZA, Chedgy ECP, Somani BK. Trends in upper tract stone disease in England: evidence from the hospital episodes statistics database. Urol Int 2016; 98: 391–396. - PubMed
    1. Geraghty RM, Jones P, Somani BK. Worldwide trends of urinary stone disease treatment over the last two decades: a systematic review. J Endourol 2017; 31: 547–556. - PubMed
    1. NHS Digital. Hospital admitted patient care activity 2018–19: procedures and interventions, 2019. https://digital.nhs.uk/data-and-information/publications/statistical/hos...
    1. Somani BK, Giusti G, Sun Yet al. . Complications associated with ureterorenoscopy (URS) related to treatment of urolithiasis: the Clinical Research Office of Endourological Society URS Global study. World J Urol 2016; 35: 675–681. - PMC - PubMed