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Contemporary Imaging Practice Patterns Following Ureteroscopy for Stone Disease.

Abstract：

BACKGROUND AND PURPOSE:Routine imaging following ureteroscopy for treatment of renal/ureteral calculi continues to be a topic of debate. However, with the increasing focus on healthcare costs and quality, judicious use of diagnostic imaging to optimize outcomes while minimizing resource utilization is a priority. We sought to identify post-ureteroscopy imaging practices among experienced urologists. MATERIALS AND METHODS:A REDcap questionnaire was sent to urologists in North America. The questionnaire surveyed demographic data, clinical volume, and imaging preferences post-ureteroscopy. Additionally, we surveyed the extent to which stone, anatomic, and procedure-related factors influenced these preferences. The likelihood of altering clinical practice and the desire for specific imaging guidelines were also assessed. The interquartile range (IQR) was utilized as a measure of median consensus. RESULTS:Three hundred twenty-two urologists completed the questionnaire. The mean number of years in practice was 18 ± 10; 82% of respondents performed more than five ureteroscopic stone procedures monthly. Routine postoperative imaging was obtained by 48% of participants as follows: ultrasound (US) (47%), kidneys, ureters, and bladder (KUB) (17%), CT (4%), intravenous pyelogram (IVP) (2%), and KUB+US (30%). Urologists who did not routinely image patients were more concerned about cost (55% vs 25%, p ≤ 0.0001), radiation exposure (69% vs 44%, p ≤ 0.0001), and diagnostic inaccuracy of US (57% vs 44%, p ≤ 0.02). These urologists were also less likely to have completed an endourology fellowship (7% vs 23%, p ≤ 0.0001). The most compelling predictors of obtaining postoperative imaging were postoperative pain and fever (median 5, IQR 1), residual stones (median 5, IQR 1), ureteral perforation (median 5, IQR 2), and presence of a solitary kidney (median 4.5, IQR 2). CONCLUSIONS:Currently, about 50% of urologists who regularly perform ureteroscopic stone procedures obtain postoperative imaging. Imaging preferences were guided by the presence of residual fragments, ureteral perforation, solitary kidney, and postoperative pain or fever.

journal_name

J Endourol

journal_title

Journal of endourology

authors

Omar M,Chaparala H,Monga M,Sivalingam S

doi

10.1089/end.2015.0088

subject

Has Abstract

pub_date

2015-10-01 00:00:00

pages

1122-5

issue

eissn

0892-7790

issn

1557-900X

journal_volume

pub_type

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Contemporary Imaging Practice Patterns Following Ureteroscopy for Stone Disease.