The efficacy and safety of ureteroscopic lithotripsy and flexible ureteroscopy with continuous anticoagulant or antiplatelet drugs: A multicenter retrospective real-world study

Abstract

Objective: The objective of this study is to assess the effectiveness and safety of ureteroscopic lithotripsy and flexible ureteroscopy (fURS) for treating patients on anticoagulant (AC) or antiplatelet (AP) medications.

Patients and Methods: The study included 213 patients with urinary stones who underwent ureteroscopic lithotripsy or fURS between January 2019 and October 2022 at the Shanghai Municipal Hospital Urology Specialist Alliance. Among these patients, 15 received AC therapy, 193 received AP therapy, and 5 received both AC and AP therapy. Patients were divided into 3 groups based on the real-world management of antithrombotic drugs: the continuation group (n = 62), the discontinuation group (n = 91), and the discontinuation and bridge heparin group (n = 60). Intraoperative and postoperative outcomes were compared among the 3 groups.

Results: Age, sex, body mass index, stone location, stone size, stone side, and residual fragments were not different among the groups. None of the patients received blood transfusions or had thromboembolic events, emergencies for gross hematuria, significant bleeding-related complications, or unplanned secondary ureteroscopic surgery. The mean duration of hospital stay of the continuation group (3.97 days) was significantly lower than that of the discontinuation group (5.99 days) and the discontinuation and bridge heparin group (5.75 days) (p < 0.001).

Conclusions: Ureteroscopic lithotripsy and fURS can be performed safely and effectively in patients on AC or AP drugs, resulting in reduced duration of hospital stay.

Keywords

Ureteroscopic lithotripsy / Flexible ureteroscopy / Anticoagulant drugs / Antiplatelet drugs

Acknowledgement

None.

Statement of ethics

This study underwent review and approval by the Ethics Review Boards of Shanghai General Hospital (clinical trial no. ChiCTR2200065923). Our study was approved by The Institutional Ethics Committee of Shanghai General Hospital. Written informed consents were obtained from all subjects. The study design and all testing procedures were performed according to the ethical standards of the Helsinki Declaration II.

Conflict of interest statement

No potential conflict of interest was reported by the authors.

Funding source

Shanghai Municipal Hospital Urology Specialist Alliance (grant no. SHDC22021314-A, SHDC22021314-B), Scientific and Technological Innovative Action Plan from Science and Technology Commission of Shanghai Municipality (grant nos. 20Y11904600 and 23141902100), Shanghai Pujiang Program (grant no. 2020PJD046), and Science and Technology Foundation of Songjiang District (grant no. 18sjkjgg13).

Author contributions

ZX, CH, LC: Analyzed the results of the study;ZX: Wrote the paper;JC, JW, DW, JD, DX, MT, XG, YP, JC, RC, PW, JJ: Performed data collection;SX, YS: Revised the paper;YS: Designed the study.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Description

We conducted a multicenter retrospective real-world study to evaluate the efficacy and safety of ureteroscopic and flexible URL for the treatment of patients undergoing AC or AP medications by comparing intraoperative and postoperative outcomes on the patients divided into the continuation group, discontinuation group, and discontinuation and bridge heparin group.

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