title: Contemporary Imaging Practice Patterns Following Ureteroscopy for Stone Disease.
abstract: OBJECTIVE
  Routine imaging following ureteroscopy for treatment of renal/ureteral calculi continues to be a topic of debate. However, with the increasing focus on healthcare costs and quality, judicious use of diagnostic imaging to optimize outcomes while minimizing resource utilization is a priority. We sought to identify post-ureteroscopy imaging practices among experienced urologists.
  
  
  METHODS
  A REDcap questionnaire was sent to urologists in North America. The questionnaire surveyed demographic data, clinical volume, and imaging preferences post-ureteroscopy. Additionally, we surveyed the extent to which stone, anatomic, and procedure-related factors influenced these preferences. The likelihood of altering clinical practice and the desire for specific imaging guidelines were also assessed. The interquartile range (IQR) was utilized as a measure of median consensus.
  
  
  RESULTS
  Three hundred twenty-two urologists completed the questionnaire. The mean number of years in practice was 18 ± 10; 82% of respondents performed more than five ureteroscopic stone procedures monthly. Routine postoperative imaging was obtained by 48% of participants as follows: ultrasound (US) (47%), kidneys, ureters, and bladder (KUB) (17%), CT (4%), intravenous pyelogram (IVP) (2%), and KUB+US (30%). Urologists who did not routinely image patients were more concerned about cost (55% vs 25%, p ≤ 0.0001), radiation exposure (69% vs 44%, p ≤ 0.0001), and diagnostic inaccuracy of US (57% vs 44%, p ≤ 0.02). These urologists were also less likely to have completed an endourology fellowship (7% vs 23%, p ≤ 0.0001). The most compelling predictors of obtaining postoperative imaging were postoperative pain and fever (median 5, IQR 1), residual stones (median 5, IQR 1), ureteral perforation (median 5, IQR 2), and presence of a solitary kidney (median 4.5, IQR 2).
  
  
  CONCLUSIONS
  Currently, about 50% of urologists who regularly perform ureteroscopic stone procedures obtain postoperative imaging. Imaging preferences were guided by the presence of residual fragments, ureteral perforation, solitary kidney, and postoperative pain or fever.
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute , The Cleveland Clinic, Cleveland, Ohio.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Omar
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute , The Cleveland Clinic, Cleveland, Ohio.
authors.forename: Hemant
authors.initials: H
authors.lastname: Chaparala
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute , The Cleveland Clinic, Cleveland, Ohio.
authors.forename: Manoj
authors.initials: M
authors.lastname: Monga
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute , The Cleveland Clinic, Cleveland, Ohio.
authors.forename: Sri
authors.initials: S
authors.lastname: Sivalingam
mesh_terms: D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D005334:Fever; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D007668:Kidney / Q000002:abnormalities / Q000601:surgery; D007669:Kidney Calculi / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery; D008297:Male; D010149:Postoperative Pain / Q000628:therapy; D011184:Postoperative Period; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D014513:Ureter / Q000601:surgery*; D014514:Ureteral Calculi / Q000601:surgery*; D018666:Ureteroscopy / Q000295:instrumentation / Q000379:methods*; D001743:Urinary Bladder / Q000601:surgery; D014551:Urinary Tract / Q000601:surgery; D014564:Urogenital Abnormalities; D014572:Urology / Q000379:methods*