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Emergency versus elective ureteroscopic treatment: what is the role of the emergency ureteroscopy approach in the definitive treatment of ureteric stones?

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Emergency versus elective ureteroscopic treatment : what role of the emergency ureteroscopy approch in the definitive

treatment of ureteric stones ?

INTRODUCTION AND OBJECTIVES: To evaluate the efficacy and safety of the ureteroscopic management of ureteral

stones immediately after a first colic attack.

METHODS: It was a prospective, unicentric and randomized study. From 2008 to 2016, 160 patients admitted for distal

ureteric stones who underwent ureteroscopy with stone retrieval. The 80 patients in group A (EMG) underwent ureteroscopy within

24 hours of admission to our emergency department, whereas the 80 patients in group B (ELC) underwent ureteroscopy more than

2 weeks after admission.

They were 138 men and 22 women with a median age of 43,5 years (20-74yers), the visual analog scale (VAS) score was

estimated at 6,2. All patients were treated by ureteroscopy (URS). We used a rigid URS 7 CH and lithoclast disintegration device.

We made an analytical study to evaluate and compare stone-free status, operate time, hospital stays, auxiliary procedures and

complications. Successful treatment was defined as lasting pain relief and complete elimination of stone fragments one month after


RESULTS: Age, sex and stone sizes were comparable in both groups. Average ages were 41,3 years and 42,4 years

among EMG and ELG, respectively. Stones had an average size of 7,8mm (in the EMG group) and 8,1mm (in the ELC group). The

overall success rates were similar in both groups (90% vs 90%). No patient experienced a major complication during or after the

procedure. Complications related to the technique were rare. It was minor complications in all cases (EMG: 4%, ELC: 7.2%, p =

0.4). ELC had a longer operative time (42 vs 63 minutes) The average length of hospital stay was similar in the 2 groups (1 day).

CONCLUSIONS: The emergency ureteroscopy was an effective and safe strategy and offers the advantages of

immediate stone fragmentation and the relief of acute-onset colic pain. These results are an argument in favor of using endourologic

treatment, in single time after failure of medical treatment.

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