Donald Kudakwashe Nyanhongo, Mohammed El Hadi, Vincent Koo
Aim: To assess the safety, efficacy, stone clearance rate and challenges posed when providing an emergency stone service as recommended by the Getting It Right First time (GIRFT) report. Methods: Retrospective analysis of the emergency and elective stone service carried out by a single dedicated stone endourologist in a district general hospital over a 4 year period. 52 patients undergoing emergency ureteroscopy (EMURS) were matched with 52 similar patients undergoing elective ureteroscopy (ELURS) and their outcomes were compared. A sub-group of 8 high risk patients who underwent EMURS were analysed separately. Results: Target stone clearance was identical in both groups at 98.1%. Complete stone clearance in the EMURS group was 90.3% compared to 96.1% in the ELURS group. There was no increase in operative time in the EMURS group with a mean time of 38.9 minutes compared to 50.2 minutes in the ELURS group. Low complication rates were seen with a 2% complication rate in patients having ELURS compared to 8% for those undergoing EMURS. The sub-group of high risk patients had a target stone clearance rate of 100% with a complete stone clearance rate of 75%. No complications were seen in this group. Conclusion: Emergency ureteroscopy is a safe procedure with low complication rates. This should therefore be offered to patients as the gold standard of care in appropriately selected patients presenting acutely with ureteric colic. The GIRFT recommendations to provide emergency stone surgery can be followed with good outcomes achievable.
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