JCU - Abstracts of the BAUS 2018 Scientific Meeting - June 2018 - 47

Abstracts

out. Sub-analysis of 4490 cases showed 25.8% of cases used
multiple stone fragmentation modalities. Nephrostomy
tube usage postoperatively is significantly reduced (72.6%
vs. 75.6% (5k), p=0.0001). Intraoperatively 78.5% of patients
were recorded as stone free, which was confirmed in
69.1% on postoperative imaging, similar to previous analyses. Complication rates are shown in Table 1.
Conclusions: PCNL practices continue to evolve in the
UK. Continued contribution of data and subsequent careful analysis of the registry allows us a better understanding
of PCNL in the UK.
P4-14 The outcomes of ureterolysis during
complex rectovaginal endometriosis surgery
in stented patients
Mikhail M1, Fisher G2, Arumuham V1, Tasleem A1,
Choong S1, Allen S1, Vashisht A2, Saridogan E2, Cutner
A2, Smith D1
1Institute of Urology, University College London Hospitals NHS
Foundation Trust, United Kingdom, 2UCLH Endometriosis Centre,
University College London Hospitals NHS Foundation Trust, United
Kingdom

Introduction: NICE guidance recommends multidisciplinary work for patients with complex rectovaginal
endometriosis. Those with ureteric involvement may
require ureterolysis, including stent insertion, following
complex or extensive dissection. We aimed to determine

the incidence of post-operative ureteric strictures in a
5-year endometriosis cohort.
Methods: 239 patients who underwent surgery for
complex pelvic endometriosis from January 2011 to
December 2015 were identified from our tertiary referral unit database. Pre-operative loin pain, hydronephrosis,
intra-operative stenting and post-operative stent management were analysed. Fisher's Exact Test was used to
determine significance.
Results: 85% of patients (203/239) did not require intraoperative stents. Of the 15% (36/239) who were stented,
22% (8/36) had pre-operative hydronephrosis, 22% (8/36)
had loin pain and 14% (5/36) had both. There was a tendency towards a greater post-operative risk in stented
patients (i.e. "high risk" intraoperative cases) compared
with unstented patients (p=0.07), but no difference in risk
in patients whose stents were removed cystoscopically or
after ureteroscopic assessment (p=1.0).
Conclusions: These data show a low overall risk of postoperative ureteric sequelae and support the conclusion that
intra-operative stent insertion for "high risk" cases allows a
similar outcome to less complex patients who did not need
stents at all. Pre-operative loin pain/hydronephrosis increases
the likelihood of needing intra-operative stents and should
be considered in operation scheduling. Post-operative ureteroscopic assessment does not appear to be needed. Instead,
unless there are specific concerns, out-patient stent removal
with a flexible cystoscope and early MAG3 renography
seems sufficient for upper tract follow up.

P4-14: Table 1
STENT STATUS

ADVERSE OUTCOME
% risk
(Number affected)

DETAILS

Unstented

0.5%
(1/203)
6.25%
(1/16)

Subsequent ureteric stricture required ureteric reimplantation.
Bilateral nephrostomies inserted for possible obstruction
on MAG3, subsequently shown to be secondary to a poorly
compliant bladder with impaired upper tract drainage.
Re-stented patient had a further ureteroscopy at 6 months,
did not require another stent, and had no obstruction on
follow-up MAG3 scan.

Stents removed by flexible cystoscopy

Ureteroscopic assessment for stent
removal or replacement

5%
(1/20)

P4-15 Fate of the antegrade ureteric
stent - An observational study and quality
improvement project
Raju J1, Thursby H1, Muthoveloe D1, George C1,
Fernando H1, Liu S1
1University Hospitals of North Midlands, Stoke-on-Trent, United
Kingdom

Introduction: Follow up of patients with antegrade ureteric stents often involves several specialties and the

potential for delayed management and forgotten stents.
This study reviews indications and outcomes of antegrade
stent procedures at one university hospital to provide
prognostic and quality improvement data.
Patients and Methods: Retrospective analysis of 152
antegrade stent procedures in 142 patients over a
27-month period with six-month minimum follow up.
Cohorts were studied according to referring specialty,
underlying pathology and intended duration of stent placement. Measured endpoints were time to stent removal,
stent exchange, death and forgotten stents.

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