‘Imaging gap’ seen in post-URS patients

San Francisco-Many urologists don't follow guidelines calling on them to image their patients after ureteroscopic stone disease treatment, researchers say.

AUA guidelines call for techniques such as renal ultrasound, x-ray, or computed tomography after each ureteroscopic treatment for stones, but in Michigan, only 48% of patients underwent such imaging, Casey A. Dauw, MD, assistant professor of urology at the University of Michigan, Ann Arbor,told Urology Times.

"We feel this is an imaging gap,” said Dr. Dauw, who reported the findings at the AUA annual meeting in San Francisco.

"We don't know how patients do if we don't image them postoperatively," he said. "We need to know our outcomes if we want to be the best at what we do. If you leave stones behind, patients typically need care down the line."

To determine how well clinicians are following the guideline, Dr. Dauw and his colleagues analyzed data from the Michigan Urologic Surgery Improvement Collaborative Reducing Operative Complications from Kidney Stones (MUSIC ROCKS), a statewide quality improvement collaborative.

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Supported by Blue Cross Blue Shield of Michigan, trained abstractors at each practice enter clinical and operative data into a central registry, Dr. Dauw explained. About 44 practices comprising more than 90% of practicing urologists in Michigan participate in MUSIC, he said. MUSIC ROCKS includes 52 urologists from 11 practices in Michigan.

This registry prospectively collected clinical data for patients undergoing ureteroscopic stone treatment, including the number who underwent ultrasound, x-ray, or CT within 60 days.

The authors identified 2,850 patients who underwent the procedure between June 2016 and January 2018. Of these, 48% had postoperative imaging studies, of which 55% were x-rays, 12.9% were ultrasound, 10.1% were CT, and 13.0% were multiple studies.

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Patients were more likely to undergo imaging if they had large stones, renal location of stones, or preoperative stents or if a ureteral access sheath was used.

These findings suggest that imaging was more likely to be performed postoperatively in more complex cases, said Dr. Dauw.

But the authors couldn't find any evidence that the type of imaging varied with such factors.

"As far as correlating with more aggressive imaging like CT scans, we didn't find any correlation whatsoever," he said.

The use of postoperative imaging varied widely across the participating practices, with some imaging more than three-fourths of patients and some imaging fewer than one-fourth.

The findings offer an opportunity to improve the quality of care for patients with urinary stone disease in Michigan, Dr. Dauw concluded.

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"Our goals going forward are to try to increase imaging appropriately following ureteroscopy," he said.

But he anticipated challenges.

"Our challenge will be to understand what the right frequency of postoperative imaging should be. We can make a compelling argument that if we are going to achieve our goal of being the best place in the world for kidney stone care, we need to know our outcomes, and one of the ways to do that is to image postoperatively."