Repeat Imaging to Avoid Surgery: An Initiative to Reduce-Negative Ureteroscopy in Patients with Ureteral Stones

Abstract

Negative ureteroscopy is a clinical occurrence defined by ureteroscopy being performed for a ureteric or renal calculus identified on radiographic imaging pre-operatively, with no calculus ultimately being identified intra-operatively due to the calculus being passed prior to the procedure being performed. This occurrence has been reported in the existing literature with rates between 6.3 and 9.8% in cohorts consisting of patients with both ureteric and renal calculi. The rates of negative ureteroscopy can be reduced by having more timely operative intervention, and by utilizing repeat pre-operative imaging when indicated. Smaller and more distal calculi are more likely to pass prior to intervention and result in a negative ureteroscopy. This study provides further information regarding the rates of negative ureteroscopy in a specific cohort of patients with only ureteric calculi. These patients did have a higher rate of negative ureteroscopy than other populations in the literature. Additionally, patients who were more symptomatic from their stone undergoing more expedited intervention were actually more likely to have passed their stone prior to intervention when compared to patients undergoing delayed intervention. This highlights the need for repeat imaging when available prior to intervention.