Can We Predict Postoperative Hydronephrosis After Ureteroscopy? Results From a Surgical Quality Collaborative

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

Journal of Urology

Abstract

INTRODUCTION AND OBJECTIVE: Postoperative hydronephrosis (postop-hydro) develops in up to 2.9% of patients after ureteroscopy (URS) yet postoperative imaging is performed in less than 50% of patients. Silent obstruction may lead to compromised renal function. Identifying patients at risk for postop-hydro may aid in refining imaging guidelines. We thus sought to understand predictive factors for development of postop-hydro after URS using a large clinical registry. METHODS: Using the Reducing Operative Complications from Kidney Stones, a statewide clinical registry of diverse practices from the Michigan Urological Surgery Improvement Collaborative (MUSIC), we retrospectively identified all URS performed for stone treatment between July 2020 and June 2023. We included patients who had pre and postoperative imaging able to detect hydronephrosis (CT or renal US) within 29 to 60 days of surgery, a timeframe intended to avoid transient hydronephrosis. Multivariable mixed effects logistic regression was performed to determine preoperative clinical factors associated with postop-hydro. RESULTS: We identified 18,785 URS performed across 31 practices. In this cohort 17,675 (94%) had preoperative CT or renal US of which 4304 (24.4%) also had postoperative imaging. Postop-hydro was seen in 434 (10.1%). Regression analysis indicated that preoperative hydronephrosis (preop-hydro) was significantly associated with increased odds of postop-hydro (OR 1.97, 95% CI 1.17-3.30, p=0.010), as well as with maximum stone diameter (OR 1.04 per mm, 95% CI 1.00-1.08, p=0.032), female gender (OR 1.40, 95% CI 1.13-1.73, p=0.002) and largest stone in the kidney (OR 1.68, 95% CI 1.30-2.18 p=0.001). In contrast, pre-URS stent placement (OR 1.13, 95% CI 0.90-1.40, p=0.3) and stones in multiple locations (OR 1.17, 95% CI 0.94-1.46, p=0.2) were not significantly associated. Females with renal stones and preop-hydro exhibited the highest risk of postop-hydro, reaching a predicted probability of nearly 30% at a stone size of 20 mm, compared to about 6% for males with ureteral stones and no preop-hydro, the lowest risk group (Figure 1). CONCLUSIONS: Postop-hydro occurs in approximately 1 in 10 patients after URS in MUSIC. Factors such as gender, stone size, stone location, and preop-hydro impact the likelihood of postop-hydro and could be used to guide imaging strategies.

Volume

213

Issue

5S

First Page

e1166

Last Page

e1166

Comments

American Urological Association Annual Meeting, April 26-29, 2025, Las Vegas, NV

DOI

10.1097/01.JU.0001110136.41716.b7.01

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