Understanding failures in getting it up: The prevalence and predictors of failed ureteral access in ureteroscopy

摘要

Introduction Failed Access ureteroscopy (FA) describes the inability to gain adequate access to a stone to allow for treatment. The purpose of this study was to identify the prevalence of, and factors predicting FA in patients presenting with renal and ureteral stones. Methods: We performed a retrospective review of all uretersocopies for ureteral stones performed by three endourologists over a six month period. All patients who underwent URS for the purpose of stone treatment were included.? Patients were excluded if they underwent ureteroscopy for non-stone diagnosis or treatment. FA was investigated in relation to demographics, medical history, stone specific characteristics, procedure specific characteristics etc. Statistical analysis consisted of descriptive statistics as well as chi-square and t-test analysis using SPSS statistical software version 23.0. Results: 188 cases were reviewed, with 8% of patients experiencing FA. Patient age, gender, BMI, ASA score, emergency cases, previous stone treatment, use of CT imaging, presence of hydronephrosis, and surgeon did not differ significantly between FA and successful access (SA) groups. Stone size (9.88±5.8 vs 8.76±4.3mm; p=0.361) was also not significantly different. However, a significant difference was noted in time from first diagnosis to ureteroscopy (128 vs 65 days; p=0.044) and in stone location 62.5% vs 22.0% proximal ureter; p=0.043; OR=4.77 (1.05-21.64) Conclusions: ?Proximal ureteric stones were more likely to result in failed access ureteroscopy, and FA procedures were more likely to be preceded by extended time from first diagnosis to ureteroscopy. Further investigation is necessary, and all endourology centres should track their own personal outcome data in order to allow for more meaningful analysis to be performed to improve patient outcomes.