PD13-07 NATURAL HISTORY, COMPLICATIONS, AND RE-INTERVENTION RATES OF ASYMPTOMATIC RESIDUAL STONE FRAGMENTS POST-URETEROSCOPY: A REPORT FROM THE EDGE RESEARCH CONSORTIUM

You have accessJournal of UrologyStone Disease: Surgical Therapy I1 Apr 2015PD13-07 NATURAL HISTORY, COMPLICATIONS, AND RE-INTERVENTION RATES OF ASYMPTOMATIC RESIDUAL STONE FRAGMENTS POST-URETEROSCOPY: A REPORT FROM THE EDGE RESEARCH CONSORTIUM Ben H. Chew, Hilary Brotherhood, Roger L. Sur, Bodo E. Knudsen, Nicole L. Miller, Courtney Yong, Tracy Marien, An-Qi Wang, Cameron Charchenko, Mitchell R. Humphreys, and Amy E. Krambeck Ben H. ChewBen H. Chew More articles by this author , Hilary BrotherhoodHilary Brotherhood More articles by this author , Roger L. SurRoger L. Sur More articles by this author , Bodo E. KnudsenBodo E. Knudsen More articles by this author , Nicole L. MillerNicole L. Miller More articles by this author , Courtney YongCourtney Yong More articles by this author , Tracy MarienTracy Marien More articles by this author , An-Qi WangAn-Qi Wang More articles by this author , Cameron CharchenkoCameron Charchenko More articles by this author , Mitchell R. HumphreysMitchell R. Humphreys More articles by this author , and Amy E. KrambeckAmy E. Krambeck More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1071AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Fragments 4mm or less that are non-obstructing and asymptomatic are termed “clinically insignificant residual fragments” (CIRFs); this designation is controversial due to high rates of re-intervention. Our objective was to examine the natural history, complication rates, 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 post-procedure with at least one KUB X-ray, US, or CT within 12 months were studied. Outcomes measured were fragment location, size, growth, passage, complication rates, and re-intervention rates. 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. Fragments > 4mm were more likely to grow over time (p<0.001) and were associated with complications (p=0.039). Logistic regression shows the original stone size (p=0.0475) to be the only significant predictor of complication. Re-intervention was predictable based on the size (p=0.017) and location of fragments (p=0.02). There was a trend towards complication depending on the location of residual fragments (p=0.068) and re-intervention with older age (p=0.075). Kaplan-Meier analysis found that dusting the stone and larger residual fragments (>4mm) were more likely to require re-intervention (p=0.004). Re-interventions included URS (58), PCNL (4), and SWL (3). CONCLUSIONS This study suggests that fragment sizes > 4mm following ureteroscopy is associated with significantly higher rates of stone growth, complications, and need for re-intervention with at least one year of follow-up. Even for fragments less than 4mm, 28% underwent stone growth and 22% suffered a complication, challenging the traditional description of CIRF. Ensuring complete stone free status is the best way to reduce the rate of complications and interventions following ureteroscopy. Rate of Complications According to Fragment Size Fragment < 4mm Fragment > 4 mm p value Passage of fragments 27.3% 26.0% 0.948 Growth of fragments 27.8% 59.2% <0.001 Occurrence of complication 22.3% 35.7% 0.039 Re-Intervention required 17.5% 38% 0.001 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e264 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ben H. Chew More articles by this author Hilary Brotherhood More articles by this author Roger L. Sur More articles by this author Bodo E. Knudsen More articles by this author Nicole L. Miller More articles by this author Courtney Yong More articles by this author Tracy Marien More articles by this author An-Qi Wang More articles by this author Cameron Charchenko More articles by this author Mitchell R. Humphreys More articles by this author Amy E. Krambeck More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...