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    Pain most common reason for post-URS ED visits

     

    There were 47 ED visits (29 by women and 18 by men, average age: 48.2 years) that occurred at an average of 8.4 days following ureteroscopy, for a rate of return of 14.2%. This rate is consistent with reports in the literature, Dr. Machen noted. For example, Bloom et al found a rate of ED return of 15.6% within 30 days in a series of 276 patients undergoing ureteroscopy (J Urol 2016; 195:1487-91). Buldu and colleagues found that 12.7% of patients were re-admitted within 30 days after flexible ureterorenoscopy for kidney stones (World J Urol 2016; 34:1291-5).

    As in these other two series, the most common presenting complaint was flank pain (28 patients; 59.6%).

    “There was no statistically significant difference in the trips to the ED based on pain medication,” said Dr. Machen.

    “In the 28 patients who presented with pain, a large percentage of them presented on the same day that their stent had been removed, whether they had pulled it themselves or had it removed as an outpatient procedure in clinic, or else that it had been removed on accident,” he said.

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    These percentages were 46.4% after the stent was self-pulled, 10.7% after the stent was inadvertently removed, and 14.3% after the stent was removed via cystoscopy in clinic. About one-fourth (28.6%) who presented with flank pain presented with the stent in place. There was no significant difference in the rate of ED visits between those who had a string attached and those who did not.

    The second most common reason for ED visit was hematuria (five patients). Nine of the 47 patients underwent intraoperative dilation of their ureters and in 29 of the 47, an access sheath was used. Fifteen of the 47 patients presenting to the ED were ultimately hospitalized.

    A multivariable analysis will assess comorbidities and their effect on returning to the ED, Dr. Machen said.

    More on Stone Disease:

    Ureteroscopy may adversely affect erectile function

    URS and ED risk: Intriguing association

    Ureteroscopy: Surgeons show techniques, tips in videos


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    Wayne Kuznar
    Wayne Kuznar is a contributor to Urology Times.

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