The following is a summary of “Imaging After Ureteroscopy: Practice Patterns, Patient Adherence and Impact on Subsequent Management in an Urban Academic Hospital System,” published in the JANUARY 2023 issue of Urology by Gupta, et al.
For a study, researchers sought to investigate predictors of imaging order, kind, and completion and to analyze the impact on patient treatment. They also sought to evaluate post-ureteroscopy (URS) imaging practice patterns.
A retrospective analysis of patients who underwent URS for nephrolithiasis at a single facility between May 2020 and May 2021 was done. They looked at the patient’s demographics, the clinical and operational factors, and the surgeons’ years of experience. They looked at post-URS imaging examinations that were done less than six months after surgery. The term “changes in patient management” was used to refer to additional imaging tests ordered or unexpected surgery that followed. Between those who had imaging ordered and those who did not, patient, provider, and surgical factors were compared.
URS was performed on 289 different patients. A total of 234 (81.0%) received post-operative imaging orders, but only 147 (62.8%) had them performed. Those who had imaging ordered and those who did not, as well as those who had imaging completed and those who did not, shared identical baseline demographics, stone, and surgical characteristics. (OR = 4.08, P =.01) Pre-operative hydronephrosis and ordering of post-operative imaging. Comparing urologists in practice for less than 5 years to those who have been doing so for more than 5 years, it was shown that the former were more likely to order post-operative imaging (<5: 90.6%, 15+: 53.7%; P <.001). 52 of the 147 patients (35.4%) who underwent imaging had their management altered; 38 patients (25.9%) had extra imaging requested; and 14 (9.5%) had a second, unanticipated operation.
Surgery experience and pre-operative hydronephrosis were the two biggest predictors of ordering post-URS imaging. In 35.4% of patients, postoperative imaging altered care. They advised the creation of regulations encouraging routine imaging for patients who had undergone ureteroscopy.