Primary ureteroscopy for the emergency management of ureteric stones: Evaluation of a novel quality improvement project and the impact on an acute stone service

Objectives: We assess the impact including safety, efficacy, and complications of a new emergency primary ureteroscopy service to improve pathways for patients with acute ureteric colic. Patients and methods: A retrospective review of patients with confirmed ureteric stones presenting to accident and emergency (A&E) department between May 2022 and May 2024 was performed. Patients were categorised on the management approach to conservative, emergency stent insertion or primary ureteroscopy. Data on demographics, outcomes, complications, waiting times, and procedures performed was collected. Results: A total of 618 patients were studied. A total of 128 patients underwent emergency ureteroscopy. A total of 124 (97%) were rendered stone free. There was one readmission with sepsis. A total of 343 patients were managed conservatively with 236 (69%) stone free at follow-up with 22 readmissions, and 82 patients were still awaiting follow-up. A total of 147 patients had temporary stents inserted, with a mean wait for ureteroscopy of 3 months. A total of 29 patients were awaiting ureteroscopy. Discussion/conclusion: Primary ureteroscopy as an emergency procedure allows immediate definitive treatment and is safe and effective, with a very low rate of complications and readmissions. We have reduced the number of stented patients added to our waiting list from the emergency pathway by 46.5%. Implementing ureteroscopy as standard practice in acute settings will align hospitals with the National Institute for Health and Care Excellence (NICE) and Getting It Right First Time (GIRFT) guidance on the acute management of ureteric stones and lead to better outcomes, less complications, improved training opportunities for residents, and reduced complaints. Level of evidence: Level IV