INTRODUCTION - Fragments smaller than 4 mm after ureteroscopy were historically considered clinically insignificant, but there is a reported 20% event rate upon follow-up even in stones smaller than 4 mm. Our objective was to examine the natural history, complications, and re-intervention rates of fragments following ureteroscopy.
METHODS - Data from 6 centers was collected retrospectively from members of the Endourology Disease Group for Excellence (EDGE) in 232 patients who had residual fragments following ureteroscopy (URS) between 2006 and 2013. Patients with fragment(s) of any size on imaging within 12 months were eligible. The primary outcome measured was stone events and secondary outcomes included stone growth, stone passage, re-intervention and complications.
RESULTS - Of the 232 subjects with fragments, 131 (56%) required no further intervention and remained asymptomatic, 34 (15%) developed complications requiring no intervention, and 67 (29%) required intervention-i. e. primary outcome stone event rate of 44%. Fragments > 4mm were more likely to grow over time (p2mm were more likely to experience growth (p
CONCLUSIONS - This study suggests that fragment size > 4mm following ureteroscopy is associated with significantly higher rates of stone growth, complications, and need for re-intervention. Ensuring complete stone free status is the most effective strategy to reduce stone events following ureteroscopy.
The Journal of urology. 2015 Nov 13 [Epub ahead of print]
Ben H Chew, Hilary L Brotherhood, Roger L Sur, An Qi Wang, Bodo E Knudsen, Courtney Yong, Tracy Marien, Nicole L Miller, Amy E Krambeck, Cameron Charchenko, Mitchell R Humphreys
The University of British Columbia, Vancouver, British Columbia. , The University of British Columbia, Vancouver, British Columbia. , University of California, San Diego, California. , University of California, San Diego, California. , The Ohio State University, Columbus, Ohio. , The Ohio State University, Columbus, Ohio. , Vanderbilt University, Nashville, Tennessee. , Vanderbilt University, Nashville, Tennessee. , The Mayo Clinic, Rochester, Minnesota. , The Mayo Clinic, Rochester, Minnesota. , The Mayo Clinic Arizona, Phoenix, Arizona.'