PD34-11 PATTERNS OF KIDNEY STONE RECURRENCE AFTER SURGERY: SURGICAL RECURRENCE COMPARED TO EMERGENCY ROOM VISITS

You have accessJournal of UrologyStone Disease: Surgical Therapy V (PD34)1 Apr 2020PD34-11 PATTERNS OF KIDNEY STONE RECURRENCE AFTER SURGERY: SURGICAL RECURRENCE COMPARED TO EMERGENCY ROOM VISITS Jeremy Hatcher, Nicholas Kavoussi*, Li Wang, Maggie Ford, Nicole Miller, Yu Shyr, and Ryan His Jeremy HatcherJeremy Hatcher More articles by this author , Nicholas Kavoussi*Nicholas Kavoussi* More articles by this author , Li WangLi Wang More articles by this author , Maggie FordMaggie Ford More articles by this author , Nicole MillerNicole Miller More articles by this author , Yu ShyrYu Shyr More articles by this author , and Ryan HisRyan His More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000905.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Kidney stone recurrence is heterogenous. Sub-populations that experience recurrence have not been well characterized. The purpose of this study was to evaluate two recurrence types: surgical recurrence, or emergency room (ER) recurrence. METHODS: A retrospective review was performed on patients who underwent kidney stone surgery between 1994-2019. Kidney stone recurrence was identified using procedure codes and ICD codes during ER visits. Recurrence episodes were validated with chart review and categorized by the initial presentation to the ER (stone event prompting an ER visit) or surgical recurrence (surgical intervention for stone at least 2 months after the initial surgery). We analyzed factors associated with recurrence type and compared recurrence groups using t-tests and Fisher exact tests. RESULTS: A total of 5,377 patients underwent kidney stone surgery, with 1020 (19%) recurrence episodes over a mean of 29±31 months of follow-up. A total of 1757 ER recurrences were initially identified based on ICD code during ER visit, but only 136 (8%; PPV=7%) were validated as true ER recurrences. Among patients with any recurrence, the initial presentation was surgical in 884 (87%). The residual fragment rate was 70% in all recurrence patients. Having a residual fragment was associated with overall, surgical, and ER recurrence, with no differences between the surgical and ER recurrence groups (p=0.61) (see Figure). Recurrence occurred in the ipsilateral kidney 51% of cases overall, and there was no difference between recurrence types (p=0.92). A greater proportion of surgical recurrence patients presented with new stone/stone growth (7/136, 5% vs 277/884, 31%; p<0.001), while more ER recurrence patients had primarily pain (107/136, 79% vs. 263/884, 30%; p<0.001). ER recurrence occurred more commonly after ureteroscopy than PCNL (107/136, 79% vs 603/884, 68%, p=0.01). Surgical recurrence occurred more commonly after PCNL than ureteroscopy (222/884, 25% vs. 17/136, 12%; p=0.02). CONCLUSIONS: Residual fragments after stone surgery are associated with both surgical and ER recurrence. Recurrence types differ by presentation and previous surgery. These data show that recurrence definitions identify distinct kidney stone patient populations. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e715-e716 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeremy Hatcher More articles by this author Nicholas Kavoussi* More articles by this author Li Wang More articles by this author Maggie Ford More articles by this author Nicole Miller More articles by this author Yu Shyr More articles by this author Ryan His More articles by this author Expand All Advertisement PDF downloadLoading ...