Presented by: Louise DUFFAUT MD
Clinical Research group on urinary lithiasis, Tenon hospital, Sorbonne Université

Introduction

Flexible Ureteroscopy (fURS) with laser lithotripsy is one of the surgical options following French CLAFU recommendations. After a renal colic, a satisfying pain management isn’t always present and can require a surgical drainage. The aime of this study is to estimate the practicability of a differed fURS in chosen patients with an ureteral lithiasis.

Materials

Patients who have been seen by a doctor for a renal colic (RC) due to a unique ureteral lithiasis and  again for persistant pain where included in a prospective way between November 2019 and May 2023, after realisation of a sterile CBEU. Where excluded patients needing an urgent drainage (acute obstructive pyelonephritis, hyperalgesic RC, acute renal insufficiency). The maximal delay between RC and fURS was inferior to 2 weeks. Where collected demographic, lithiasis (maximal diameter, density, localisation) and surgical (equipment, length, lithotripsy parameters) characteristics. Complications where classified according to Clavien-Dindo. The without residual fragments (WRF) rate was evaluated by endoscopy and on the post-surgical imaging.

Results

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23 patients where included, with a median age of 55 years, the sex ratio was 2,1 (M) with a median BMI of 21 Kg/cm² (Table1). 57% had preceding surgical treatment of lithiasis. The lithiasis where located for respectively 31%, 18% and 36% in the pelvic ureter, the lumbar, or pyelo-ureteric junction. They presented a median diameter and volume of 9,5(7-12)mm and 540(303-660)mm³.  fURS was possible for all the patients, without a ureteral sheath, with an optic,  numeric and single use ureteroscope in respectively  55,3, 13 et 21,7% (Table 2). TFL laser was employed in 91,4 % of patients, using low energy, low frequency and power. The WRF was assessed at 100%, without urétéral stenosis at 3 month post surgery. Despite a negative pre-surgery CBEU, one patient presented a febrile urinary infection after surgery.

Conclusion

Our study shows that deferred emergency fURS in chosen patients with a ureteral lithiasis is feasible with a low complication rate, including absence of post-operative ureteral stenosis. A multi-centric study could confirm the results of this pilot study as well as eligible patients.

Funding

No funding 

Lead Authors

Frederic PANTHIER, MD, MSc
Clinical Research group on urinary lithiasis, Tenon hospital, Sorbonne Université

Co-Authors

Marie Chicaud, MD
Clinical Research group on urinary lithiasis, Tenon hospital, Sorbonne Université

Stessy Kutchukian, MD
Clinical Research group on urinary lithiasis, Tenon hospital, Sorbonne Université

Catalina Solano, MD
Clinical Research group on urinary lithiasis, Tenon hospital, Sorbonne Université

Luigi Candela, MD
Clinical Research group on urinary lithiasis, Tenon hospital, Sorbonne Université

Mariela Corrales, MD
Clinical Research group on urinary lithiasis, Tenon hospital, Sorbonne Université

Steeve Doizi, MD, PhD
Clinical Research group on urinary lithiasis, Tenon hospital, Sorbonne Université

Olivier Traxer, MD, PhD
Clinical Research group on urinary lithiasis, Tenon hospital, Sorbonne Université