BACKGROUND AND PURPOSE: Routine imaging following ureteroscopy for treatment of renal/ureteral calculi continues to be a topic of debate.
However, with the increasing focus on healthcare costs and quality, judicious use of diagnostic imaging to optimize outcomes while minimizing resource utilization is a priority. We sought to identify post-ureteroscopy imaging practices amongst experienced urologists.
MATERIALS AND METHODS: A REDcap questionnaire was sent to urologists in North America. The questionnaire surveyed demographic data, clinical volume, and imaging preferences post-ureteroscopy. Additionally, we surveyed the extent to which stone, anatomic, and procedure-related factors influenced these preferences. The likelihood of altering clinical practice and the desire for specific imaging guidelines were also assessed. The Interquartile range (IQR) was utilized as a measure of median consensus.
RESULTS: Three hundred twenty two urologists completed the questionnaire. The mean number of years in practice was 18±10; 82% of respondents performed more than 5 ureteroscopic stone procedures monthly. Routine postoperative imaging was obtained by 48% of participants as follows: US (47%), KUB (17%), CT (4%), IVP (2%), and KUB + US (30%). Urologists who did not routinely image patients were more concerned about cost (55% Vs. 25%, p= < .0001), radiation exposure (69% vs. 44%, p= < .0001), and diagnostic inaccuracy of US (57% vs. 44%, p= < 0.02). These urologists were also less likely to have completed an Endourology fellowship (7% vs. 23%, p= < .0001).The most compelling predictors of obtaining postoperative imaging were post-op pain and fever (median 5, IQR 1), residual stones (median 5, IQR 1), ureteral perforation (median 5, IQR 2), and presence of a solitary kidney (median 4.5, IQR 2).
CONCLUSIONS: Currently, about 50% of urologists who regularly perform ureteroscopic stone procedures obtain post-op imaging. Imaging preferences were guided by the presence of residual fragments, ureteral perforation, solitary kidney, and postoperative pain or fever.
Written by:
Omar M, Chaparala H, Monga M, Sivalingam S. Are you the author?
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Reference: J Endourol. 2015 May 12. Epub ahead of print.
doi: 10.1089/end.2015.0088
PubMed Abstract
PMID: 25963170