The Importance of Stone Retrieval in the Modern Management of Urolithiasis

Main Article Content

Aman Khela
Manoj Ravindraanandan
Adam Jones
Adnan Asghar
Wasim Mahmalji

Keywords

Urolithiasis, Ureterolithiasis, Calculi, CT Scan, Conservative Management

Abstract

Background and Objectives
World urolithiasis is increasing with a 70% increase in hospital admissions between 2000 and 2015. Stone analysis can allow for the identification of metabolic conditions and stone retrieval may decrease the need for follow-up imaging, reducing costs and patient radiation.
This study aimed to see if introducing the UroPro© Stone catcher into our practise would increase stone retrieval thus increasing stone analysis rates and reducing the need for follow-up imaging.


Methods
Between November 2018 and July 2019 patients receiving ESWL or being conservatively managed for a ureteric stone were discharged with a Paramount Medical solutions UroPro© Stone Catcher. Both groups of patients were asked to complete a patient survey regarding the product.


Results
There were 27 patients recruited. 14 from SWL and 13 from acute admissions. 22 responses were received in total: 10 from acute admissions and 12 from ESWL. 5 patients were uncontactable. 30% (n=3) of the acute patients passed and caught a stone negating the need for further imaging. 30% (n=3) did not pass their stone and required either emergency or elective intervention. 1 patient passed his stone into the toilet whilst another had the stone in their bladder when they were taken to theatre. 20% (n=2) patients but did not catch their stone requiring follow-up imaging which revealed the stone had passed. In the ESWL group 16% (n=2) caught a fragment, the rest found they only passed dust. Stone analysis was performed in all 5 patients who returned a fragment.


A total of 73% (n=16) of patients reported over 75% compliance with the stone catcher. 59% (n=13) reported that the stone catcher was easy to use whilst 27% (n=6) found it hard. When given a choice of sieving methods. Only 6 patients (27%) would opt to use the stone catcher with over half, 64% (n=14), preferring more traditional methods of sieving urine over the stone catcher.


the patient 0.5 to 2.8 mSv of radiation from follow-up imaging, the NHS circa £100 per unnecessary follow-up computed tomography (CT) scan and aids metabolic analysis. Over time both factors may be substantial. Therefore, emphasizing the benefits and importance to patients to sieve their urine regardless of the techniques is paramount in the modern management of urolithiasis.
Conclusion
The UroPro© stone catcher did increase the number of stones caught and sent for analysis. However, many patients preferred the older ‘sieving’ methods. Stone catchers retail at £5.50, therefore ‘sieving’ remains more cost-effective. Stone retrieval in any form remains advantageous as confirming stone passage saves

Downloads

Download data is not yet available.
Abstract 21 | pdf Downloads 42

References

1. Hospital Episode Statistics (HES) Data 2017-18. Avail-able at: https://digital.nhs.uk/data-and-information/ publications/statistical/hospital-admitted-patient-care -activity/2017-18.
2. Tsiotras A, Smith D, Pearce I, O’Flynn K, Wiseman O. British Association of Urological Surgeons standards for management of acute ureteric colic. J Clin Urol 2018;11(1):58–61.
3. NICE. NICE Guideline 118. Renal and ureteric stones: assessment and management. 2019. Available at: https:// www.baus.org.uk/_userfiles/pages/files/professionals/ sections/endourology/Renal%20and%20Ureteric%20 Colic%20Jan%202019.pdf.
4. Turk C, Neisius A, Petrik A, Seitz C, Skolarikos A, Thomas K, Donaldson JF, Drake T, Grivas N, Ruhayel Y. EAU Guidelines on Urolithiasis 2018. Available at: https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Urolithiasis-2018-large-text.pdf.
5. Pearle MS, Goldfarb DS, Assimo DG, Curhan G, Denu-Ciocca CJ, Matlaga BR, Monga M, Penniston KL, Preminger GM, Turk TMT, White JR. Medical management of kidney stones. AUA Guideline; 2019. Available at: https://www.auanet.org/guidelines/ kidney-stones-medical-mangement-guideline
6. Miller OF, Kane CJ. Time to stone passage for observed ureteral calculi: A guide for patient education. J Urol 1999;162:(3)688–91.
7. Yallapa S, Amer T, Jones P, Greco F, Tailly T, Somani BK, Umez-Eronini N, Aboumarzou OM. Natural history of conservatively managed ureteral stones: analysis of 6600 patients. J Endourol 2018;32:( 5)371–79.
8. Jendeberg J, Geijer H, Alshamari M, Cierzniak B, Lidén M. Size matters: The width and location of a ureteral stone accurately predict the chance of spontaneous passage. Eur Radiol 2017;27(11):4775–785.
9. Robertson R, Wenzel L, Thompson J, Charles A. Under-standing NHS financial pressures; 2017; Available at: https://www.kingsfund.org.uk/sites/default/files/field/ field_publication_file/Understanding%20NHS%20 financial%20pressures%20-%20full%20report.pdf.
10. The British Medical Association. Working in a system that is under pressure; 2018. Available at: https:// www.bma.org.uk/collective-voice/influence/key-negotiations/nhs-pressures/working-in-a-system-under -pressure.
11. Niblett DJ. Pressures in outpatient clinics: Putting up with overcrowded clinics disguises need for change. Br Med Assoc 1998;317:541.
12. Roberts WW, Cadeddu JA, Macali S, Kavoussi LR, Moore RG. Ureteral stricture formation after removal of impacted calculi. J Urol 1008;159(3):723–26.
13. ICRP Publication 60: Recommendations of the Inter-national Commission on Radiological Protection, 60. Annals of the ICRP 1991;21:1–3.
14. Sodickson A, Baeyens PF, Andriole KP, et al. Recur-rent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology 2009;251:175–84.
15. Brenner DJ, Hall EJ. Computed tomography: an in-creasing source of radiation exposure. N Engl J Med 2007;357:2277–84.
16. Preston DL, Shimizu Y, Pierce DA, Suyama A, and Mabuchi K. Studies of mortality of atomic bomb sur-vivors. report 13: solid cancer and noncancer disease mortality. 1950–1997. Radiat Res 2003:160(4):381–407.
17. Hyams ES, Shah O. Evaluation and follow-up of patients with urinary lithiasis: minimizing radiation exposure. Curr Urol Rep 2010;11(2):80–86.
18. Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R, Gonzalez AB, Miglioretti D. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 2009;169(22):2078–86.