WCE 2017: “Stone-less” or “Negative” Ureteroscopy – A Part of Endourologic Routine or Avoidable Source of Frustration?

Vancouver, Canada (UroToday.com) Dr. Sabler, the endourology fellow from Hadassah Hebrew University Medical Center presented on “stone-less/negative” ureteroscopy. A “negative” ureteroscopy is a procedure performed with the intent of removing a kidney or ureteral stone, but in which no stone is noted. It may occur when the stone is found to have already been passed or located outside of the collecting system. Not finding a stone during the procedure causes frustration to the endourologist, patient and his/her family.

In this study, they compared patients with a “negative” ureteroscopy to those with a  therapeutic procedure (i.e. stone found). From 560 patients, they identified 16 (2.8%) patients that had a “negative” ureteroscopy. Dr Sabler reported that these patients with “negative” ureteroscopy were more likely to be female and had a lower density and lower stone burden. In addition, there was a trend towards distal stone location and “negative” ureteroscopy.

In their presentation they indicated that they attempt to scan every patient prior to their surgery, and the audience asked what kind of imaging they do and if they would recommend non-contrast CT scans for every stone patient. They responded that their imaging ranges from abdominal x-rays, ultrasounds, to CT scans and that we should do whatever is necessary to find/detect the stones. 

Dr Sabler concluded that 2.8% are useless procedures with same complication profile as therapeutic ones. Risk factors include female gender, radiolucent, small stones, and possibly distal stones. As such, they advocated for the development of clear preoperative imaging protocol in an attempt to decrease the number of useless invasive procedures.

Presented by: Itay M. Sabler 

Authors: Itay M. Sabler, Aiman Isid, Amitay Lorber, Arie Latke, Guy Hidas, Ezekiel H Landau, Vladimir Yutkin, Dov Pode, Ofer N. Gofrit, Mordechai Duvdevani
Affiliation: Hadassah Hebrew University Medical Center, Jerusalem, Israel 

Written by: Egor Parkhomenko, Department of Urology, University of California-Irvine at 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada.