Success rate of repeat flexible ureteroscopy following previous failed access: An analysis of stent duration.

Introduction: Approximately 8% of patients that undergo therapeutic or diagnostic ureteroscopy will have the procedure aborted and ureter stented due to failed access. The primary objective of this study was to assess mean stent duration prior to repeat ureteroscopy and to calculate the associated successful access rate.

Methods: This retrospective, descriptive study evaluated all patients undergoing interval ureteroscopy following a failed procedure by endourologic surgeons at the University of Alberta from 2016-2018. Patients declining interval ureteroscopy, or those with malignant/known ureteral strictures were excluded from the study. The primary outcome measures were median time to salvage ureteroscopy and the rate of successful access of the repeat procedure.

Results: A total of 119 patients were identified as having a failed ureteroscopy during our study period. First-time and recurrent stone formers accounted for 64 (53.8%) and 47 (39.5%) patients, respectively. Median stent duration to second procedure was 17 days (average 20, range 10-84). Most patients had their repeat ureteroscopy at 14 days or greater (81.5%); 22 (18.5%) patients had their repeat ureteroscopy between 10 and 13 days. The success rate of a second ureteroscopy after stenting was 99.2% (118/119).

Conclusions: Ureteric stenting following failed ureteroscopy leads to exceedingly high rates of successful access at interval procedure (99.2%). The standard duration of ureteric stenting employed at our institution is two weeks. Of the patients that underwent an accelerated second procedure (between 10-13 days of stenting), all had successful access at their interval procedure.