The American Urological Association guidelines state that continuing anticoagulation (AC) and antiplatelet (AP) agents during ureteroscopy (URS) is safe. Through a multi-institutional retrospective study, we sought to determine whether pre-stenting in patients on AP or AC was associated with fewer URS bleeding-related complications.
A series of 8,614 URS procedures performed across three institutions (April 2010 - September 2017) was electronically reviewed for AC/AP use at time of URS. Records indicating AC or AP use at time of URS were then manually reviewed to characterize intraoperative and 30-day postoperative (intraoperative bleeding, postoperative hematuria, emergency department visits, hospital readmission, unplanned reoperation, phone calls, and other minor 30-day complications).
A total of 293 identified URS procedures were completed on patients on AC/AP therapy-112 cases were on AC only (38 were pre-stented), 158 on AP only (51 pre-stented), and 23 on both AP and AC (8 pre-stented). Patient characteristics and comorbidities were similar between the pre-stented and non-pre-stented groups. For AC and AP subjects, pre-stenting did not decrease the composite risk of bleeding complications (10.3% pre-stent vs 12.2% non-pre-stent, p=0.6). Pre-stented patients did have a significantly lower likelihood of requiring an unplanned reoperation (1.0% vs 5.6%, p=0.04). In the subgroup of patients on AP alone, pre-stented patients had significantly fewer episodes of intraoperative bleeding (0% vs 9%, p=0.04), unplanned reoperations (0% vs 6.5%, p=0.02), and 30-day complications (14% vs 27%, p=0.05). In the subgroup of patients on AC alone, there were no significant differences in outcomes based on stent status.
In this multi-institutional study, we found that pre-stenting before URS was not associated with fewer bleeding complications. However, pre-stenting appeared to be associated with improved outcomes for those patients on AP therapy. These results suggest a need for prospective studies to clarify the role of pre-stenting for URS.
Journal of endourology. 2023 Sep 07 [Epub ahead of print]
Jonathan Henry Berger, Thomas DiPina, Luay Alshara, Carlos Alfredo Batagello, Joshua Heiman, Tim Large, Sri Sivalingam, Roger L Sur, Amy Krambeck, Seth K Bechis
University of California San Diego, 8784, Urology, UC San Diego Health, 200 West Arbor Drive #8897, San Diego, CA 92103-7897, La Jolla, California, United States, 92093-0021; ., University of California San Diego Health System, 21814, Urology, San Diego, California, United States; ., Albany Medical Center, 138207, Glickman Urology and Kidney Institute, Cleveland, Ohio, United States; ., Universidade de Sao Paulo Hospital das Clinicas, 117265, Section of Endourology, Division of Urology, Sao Paulo, São Paulo, Brazil; ., Indiana University School of Medicine, 12250, Urology, Indianapolis, Indiana, United States; ., Indiana University School of Medicine, 12250, Urology, 1801 N Senate Blvd, Suite 220, Indianapolis, Indiana, United States, 46202; ., University of Wisconsin-Madison, 5228, Urology, Madison, Wisconsin, United States; ., UC San Diego, 8784, Urology, San Diego, California, United States; ., Northwestern University Feinberg School of Medicine, 12244, Urology, Chicago, Illinois, United States; ., University of California San Diego Health System, 21814, Urology, San Diego, California, United States; .