Acute management of ureteric colic in a large tertiary centre; a re-audit and comparison to BAUS guidelines
BAUS ePoster online library. Abroaf A. 06/21/21; 319120; p8-2
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Mr. Ahmed- Abroaf
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Abstract
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Introduction
Considerable pressure exists to deliver timely treatment for patients with acute ureteric colic. We conducted a re-audit of our practice measured against BAUS guidelines to determine an improvement in our stone service.
Patients and Methods
A prospective analysis of 130 patients admitted over 3 months (October to December 2019) with acute ureteric colic. Data was collected from records and outcomes compared to our previous audit (from 2018).
Results
Patient demographics were comparable: admissions 43/month, average age 54 years, median stone size 6mm, stone location (45 % distal-, 36 % proximal-,19% mid-ureteric). Sepsis rates were identical (17%) and managed with stent insertion. For non-septic patients, 51 % (previously 59%) underwent primary treatment (36 ureteroscopy/stent, 18 ESWL) and 49 % (previously 41%) conservative management. In theatre, primary ureteroscopy was attempted in 75% cases (previously 62%) and successful in 81%. Median time to primary ureteroscopy/stent insertion remained ≤24 hours; primary ESWL improved to ≤48 hours (previously ≤72 hours). Median time from stent insertion to definitive ureteroscopy was 8.9 weeks (previously 6.6 weeks). For patients managed conservatively, median time to outpatient review was 6.7 weeks (previously 5.4 weeks). For ureteric stents, 100 % were removed <2 weeks post-ureteroscopy (previously 89%).
Conclusions
Increasing emergency slots for acute onsite ESWL, rates of emergency primary ureteroscopy and introducing nurse-specialist stent removal (Isiris system) have enabled us to achieve primary intervention ≤48 hours and stent removal <2 weeks. Prolonged waiting times for definitive ureteroscopy and outpatient review remain challenging to address, particularly in the era of COVID-19.
Considerable pressure exists to deliver timely treatment for patients with acute ureteric colic. We conducted a re-audit of our practice measured against BAUS guidelines to determine an improvement in our stone service.
Patients and Methods
A prospective analysis of 130 patients admitted over 3 months (October to December 2019) with acute ureteric colic. Data was collected from records and outcomes compared to our previous audit (from 2018).
Results
Patient demographics were comparable: admissions 43/month, average age 54 years, median stone size 6mm, stone location (45 % distal-, 36 % proximal-,19% mid-ureteric). Sepsis rates were identical (17%) and managed with stent insertion. For non-septic patients, 51 % (previously 59%) underwent primary treatment (36 ureteroscopy/stent, 18 ESWL) and 49 % (previously 41%) conservative management. In theatre, primary ureteroscopy was attempted in 75% cases (previously 62%) and successful in 81%. Median time to primary ureteroscopy/stent insertion remained ≤24 hours; primary ESWL improved to ≤48 hours (previously ≤72 hours). Median time from stent insertion to definitive ureteroscopy was 8.9 weeks (previously 6.6 weeks). For patients managed conservatively, median time to outpatient review was 6.7 weeks (previously 5.4 weeks). For ureteric stents, 100 % were removed <2 weeks post-ureteroscopy (previously 89%).
Conclusions
Increasing emergency slots for acute onsite ESWL, rates of emergency primary ureteroscopy and introducing nurse-specialist stent removal (Isiris system) have enabled us to achieve primary intervention ≤48 hours and stent removal <2 weeks. Prolonged waiting times for definitive ureteroscopy and outpatient review remain challenging to address, particularly in the era of COVID-19.
Introduction
Considerable pressure exists to deliver timely treatment for patients with acute ureteric colic. We conducted a re-audit of our practice measured against BAUS guidelines to determine an improvement in our stone service.
Patients and Methods
A prospective analysis of 130 patients admitted over 3 months (October to December 2019) with acute ureteric colic. Data was collected from records and outcomes compared to our previous audit (from 2018).
Results
Patient demographics were comparable: admissions 43/month, average age 54 years, median stone size 6mm, stone location (45 % distal-, 36 % proximal-,19% mid-ureteric). Sepsis rates were identical (17%) and managed with stent insertion. For non-septic patients, 51 % (previously 59%) underwent primary treatment (36 ureteroscopy/stent, 18 ESWL) and 49 % (previously 41%) conservative management. In theatre, primary ureteroscopy was attempted in 75% cases (previously 62%) and successful in 81%. Median time to primary ureteroscopy/stent insertion remained ≤24 hours; primary ESWL improved to ≤48 hours (previously ≤72 hours). Median time from stent insertion to definitive ureteroscopy was 8.9 weeks (previously 6.6 weeks). For patients managed conservatively, median time to outpatient review was 6.7 weeks (previously 5.4 weeks). For ureteric stents, 100 % were removed <2 weeks post-ureteroscopy (previously 89%).
Conclusions
Increasing emergency slots for acute onsite ESWL, rates of emergency primary ureteroscopy and introducing nurse-specialist stent removal (Isiris system) have enabled us to achieve primary intervention ≤48 hours and stent removal <2 weeks. Prolonged waiting times for definitive ureteroscopy and outpatient review remain challenging to address, particularly in the era of COVID-19.
Considerable pressure exists to deliver timely treatment for patients with acute ureteric colic. We conducted a re-audit of our practice measured against BAUS guidelines to determine an improvement in our stone service.
Patients and Methods
A prospective analysis of 130 patients admitted over 3 months (October to December 2019) with acute ureteric colic. Data was collected from records and outcomes compared to our previous audit (from 2018).
Results
Patient demographics were comparable: admissions 43/month, average age 54 years, median stone size 6mm, stone location (45 % distal-, 36 % proximal-,19% mid-ureteric). Sepsis rates were identical (17%) and managed with stent insertion. For non-septic patients, 51 % (previously 59%) underwent primary treatment (36 ureteroscopy/stent, 18 ESWL) and 49 % (previously 41%) conservative management. In theatre, primary ureteroscopy was attempted in 75% cases (previously 62%) and successful in 81%. Median time to primary ureteroscopy/stent insertion remained ≤24 hours; primary ESWL improved to ≤48 hours (previously ≤72 hours). Median time from stent insertion to definitive ureteroscopy was 8.9 weeks (previously 6.6 weeks). For patients managed conservatively, median time to outpatient review was 6.7 weeks (previously 5.4 weeks). For ureteric stents, 100 % were removed <2 weeks post-ureteroscopy (previously 89%).
Conclusions
Increasing emergency slots for acute onsite ESWL, rates of emergency primary ureteroscopy and introducing nurse-specialist stent removal (Isiris system) have enabled us to achieve primary intervention ≤48 hours and stent removal <2 weeks. Prolonged waiting times for definitive ureteroscopy and outpatient review remain challenging to address, particularly in the era of COVID-19.
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