PMID- 37675902
OWN - NLM
STAT- MEDLINE
DCOM- 20231113
LR  - 20231218
IS  - 1557-900X (Electronic)
IS  - 0892-7790 (Linking)
VI  - 37
IP  - 11
DP  - 2023 Nov
TI  - The Effect of Pre-Stenting on Bleeding-Related Complications Following 
      Ureteroscopy in Patients on Anticoagulation or Antiplatelet Therapy.
PG  - 1174-1178
LID - 10.1089/end.2023.0300 [doi]
AB  - Introduction: The American Urological Association guidelines state that 
      continuing anticoagulant (AC) and antiplatelet (AP) agents during ureteroscopy 
      (URS) is safe. Through a multi-institutional retrospective study, we sought to 
      determine whether pre-stenting in patients on AP or AC was associated with fewer 
      URS bleeding-related complications. Methods: A series of 8614 URS procedures 
      performed across three institutions (April 2010 to September 2017) was 
      electronically reviewed for AC/AP use at time of URS. Records indicating AC or AP 
      use at time of URS were then manually reviewed to characterize intraoperative and 
      30-day postoperative (intraoperative bleeding, postoperative hematuria, emergency 
      department visits, hospital readmission, unplanned reoperation, phone calls, and 
      other minor 30-day complications). Results: A total of 293 identified URS 
      procedures were completed on patients on AC/AP therapy-112 cases were on AC only 
      (38 were pre-stented), 158 on AP only (51 pre-stented), and 23 on both AP and AC 
      (8 pre-stented). Patient characteristics and comorbidities were similar between 
      the pre-stented and non-pre-stented groups. For AC and AP subjects, pre-stenting 
      did not decrease the composite risk of bleeding complications (10.3% pre-stent vs 
      12.2% non-prestent, p = 0.6). Pre-stented patients did have a significantly lower 
      likelihood of requiring an unplanned reoperation (1.0% vs 5.6%, p = 0.04). In the 
      subgroup of patients on AP alone, pre-stented patients had significantly fewer 
      episodes of intraoperative bleeding (0% vs 9%, p = 0.04), unplanned reoperations 
      (0% vs 6.5%, p = 0.02), and 30-day complications (14% vs 27%, p = 0.05). In the 
      subgroup of patients on AC alone, there were no significant differences in 
      outcomes based on stent status. Conclusions: In this multi-institutional study, 
      we found that pre-stenting before URS was not associated with fewer bleeding 
      complications. However, pre-stenting appeared to be associated with improved 
      outcomes for those patients on AP therapy. These results suggest a need for 
      prospective studies to clarify the role of pre-stenting for URS.
FAU - Berger, Jonathan H
AU  - Berger JH
AD  - Department of Urology, University of California, San Diego, San Diego, 
      California, USA.
FAU - DiPina, Thomas
AU  - DiPina T
AD  - Department of Urology, University of California, San Diego, San Diego, 
      California, USA.
FAU - Alshara, Luay
AU  - Alshara L
AD  - Glickman Urology and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
FAU - Batagello, Carlos
AU  - Batagello C
AD  - Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical 
      School, Sao Paulo, Brazil.
FAU - Heiman, Joshua
AU  - Heiman J
AD  - Department of Urology, Indiana University School of Medicine, Indianapolis, 
      Indiana, USA.
FAU - Large, Tim
AU  - Large T
AD  - Department of Urology, Indiana University School of Medicine, Indianapolis, 
      Indiana, USA.
FAU - Sivalingam, Sri
AU  - Sivalingam S
AD  - Glickman Urology and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
FAU - Sur, Roger L
AU  - Sur RL
AD  - Department of Urology, University of California, San Diego, San Diego, 
      California, USA.
FAU - Krambeck, Amy
AU  - Krambeck A
AD  - Department of Urology, Northwestern University Feinberg School of Medicine, 
      Chicago, Illinois, USA.
FAU - Bechis, Seth K
AU  - Bechis SK
AD  - Department of Urology, University of California, San Diego, San Diego, 
      California, USA.
LA  - eng
PT  - Journal Article
DEP - 20231017
PL  - United States
TA  - J Endourol
JT  - Journal of endourology
JID - 8807503
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Humans
MH  - *Ureteroscopy/adverse effects/methods
MH  - Platelet Aggregation Inhibitors/adverse effects
MH  - *Ureteral Calculi/surgery
MH  - Retrospective Studies
MH  - Prospective Studies
MH  - Anticoagulants/adverse effects
MH  - Hemorrhage/etiology
MH  - Stents/adverse effects
MH  - Treatment Outcome
MH  - Postoperative Complications/etiology
OTO - NOTNLM
OT  - anticoagulation
OT  - antiplatelet
OT  - complications
OT  - nephrolithiasis
OT  - ureteral stent
OT  - ureteroscopy
OT  - urolithiasis
EDAT- 2023/09/07 12:42
MHDA- 2023/11/13 06:43
CRDT- 2023/09/07 07:43
PHST- 2023/11/13 06:43 [medline]
PHST- 2023/09/07 12:42 [pubmed]
PHST- 2023/09/07 07:43 [entrez]
AID - 10.1089/end.2023.0300 [doi]
PST - ppublish
SO  - J Endourol. 2023 Nov;37(11):1174-1178. doi: 10.1089/end.2023.0300. Epub 2023 Oct 
      17.