Mp30-20 Is Pulsed Fluoroscopy Safe for Emergent Ureteral Stent Insertion?

You have accessJournal of UrologyImaging/Uroradiology II (MP30)1 May 2024MP30-20 IS PULSED FLUOROSCOPY SAFE FOR EMERGENT URETERAL STENT INSERTION? Evan Seibly, Jammie-Lyn Quines, Grant Sajdak, Ala'a Farkouh, Akin S. Amasyali, and D. Duane Baldwin Evan SeiblyEvan Seibly , Jammie-Lyn QuinesJammie-Lyn Quines , Grant SajdakGrant Sajdak , Ala'a FarkouhAla'a Farkouh , Akin S. AmasyaliAkin S. Amasyali , and D. Duane BaldwinD. Duane Baldwin View All Author Informationhttps://doi.org/10.1097/01.JU.0001009416.90901.7b.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical decompression of infected obstructive ureteral stones is a common urologic emergency requiring immediate attention. An incorrectly placed stent could result in life-threatening complications. Pulsed fluoroscopy has been shown to be safe in many elective urologic indications, but its safety has not been demonstrated in emergent kidney decompression. The purpose of this study was to compare surgical outcomes and radiation exposure between pulsed and continuous fluoroscopy during emergent ureteral stent placement. METHODS: A retrospective review was performed on patients requiring emergent ureteral stenting due to urolithiasis at a single institution from 2021 to 2023. Baseline demographics, surgical parameters, postoperative outcomes, and radiation exposure parameters were recorded and compared between stents placed using pulsed and continuous fluoroscopy. Chi-square test and t-test were used to compare outcomes, with p-value <0.05 considered significant. RESULTS: In the 117 patients who underwent emergent ureteral stent placement, pulsed fluoroscopy was utilized in 51 cases (43.6%). At baseline, there was no significant difference in age, sex, BMI, stone size, stone location, or laterality between the pulsed and continuous fluoroscopy groups. Obstruction and hydronephrosis were higher in the pulsed fluoroscopy group (98% vs 87.9%; p=0.04). Operative times were similar between the two groups (19.1 vs 19.4 min; p=0.86). In all cases with pulsed fluoroscopy, retrograde pyelography was performed and was adequate (100% vs 97%; p=0.2). There was a significant reduction when using pulsed fluoroscopy in fluoroscopy time (8.6 vs 15.4 sec; p=0.011), cumulative radiation dose (1.9 vs 4.6 mGy; p=0.007), and dose area product (0.82 vs 1.7 Gy.cm2; p=0.023). All stents were inserted successfully with adequate renal decompression, and none required repositioning in either group. Postoperatively, there was no difference in ICU admission rates (3.9% vs 7.6%; p=0.41), need for pressors (7.3% vs 13.6%; p=0.32), overall complication rates (7.3% vs 4.5%; p=0.44), or length of stay (4.1 vs 3.6 days; p=0.56) between the pulsed and continuous fluoroscopy groups. CONCLUSIONS: In experienced hands, pulsed fluoroscopy provides all information necessary to allow safe and efficient renal decompression. This study demonstrates another urologic procedure which can be safely performed using radiation reduction strategies in harmony with the As Low As Reasonably Achievable (ALARA) principle. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e501 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Evan Seibly More articles by this author Jammie-Lyn Quines More articles by this author Grant Sajdak More articles by this author Ala'a Farkouh More articles by this author Akin S. Amasyali More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement PDF downloadLoading ...