AUA 2018: A Novel Concept for Reporting Outcomes of a Successful Treatment in Endourology for Stones: The Stone-Fecta

San Francisco, CA USA ( Dr. Giovanni Cacciamani, a fellow from the University of Southern California, presented his data on a novel concept for a system for reporting outcomes during URS/RIRS for stones, titled the STONEfecta (Successful Treatment Outcomes in Endourology). Dr. Cacciamani and his team wanted to develop a system to track and influence management decisions of URS and RIRS procedures, as the number of treatments needed to reach stone free rates in the safest way possible in terms of infections and intraoperative complications represents a concern for both patients and surgeons. This system would have three primary outcomes, including single-procedure stone-free rate, absence of major urinary tract infections (UTI) and iatrogenic of urothelial injuries. From 2011-2017, Dr. Cacciamani and his team prospectively collected and analyzed data on 418 patients who underwent URS/RIRS with a single expert surgeon.

This study only included patients with a single stone without any anatomical native or surgical dimorphisms and neurological diseases, which can considerably affect the postoperative outcomes. The inclusion criteria was narrow to separate confounders in order to demonstrate the efficacy of the STONEfecta concept. Patients who concurrently attained a stone-free rate in one procedure, no major urinary tract infections (UTIs), and no urothelial iatrogenic injuries were considered to have achieved the “STONEfecta.”

The results of the study revealed that with regards to single-procedure stone-free rate, no UTI, and no iatrogenic urological complication rates at a mean follow-up of 4.17 (7.01) months were 82.3%, 97.5%, and 96.29%, respectively. STONEfecta rate at 4 months was 77.8%. STONEfecta indicated that reduced stone size, urethral location, and the “optical dilation” technique are predictor factors for a successful treatment.

Dr. Cacciamani discussed the limitations of this study, including the fact that the STONEfecta outcomes are based on procedures performed by a single, expert surgeon and the narrow inclusion criteria for patient population. In conclusion, Dr. Cacciamani and his team presented the first method that incorporates crucial criteria in terms of outcomes reporting after URS/RIRS for stones. STONEfecta outcomes truthfully represent patients’ and surgeon expectations following URS/RIRS. This novel system may be used when counseling patients, in the procedure scheduling, and could be considered for the improvement of standardized quality assessment during surgeon training.

Presented by: Giovanni Cacciamani , MD

Written by: Taylor Capretz, Department of Urology, University of California-Irvine at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA