Conservative management of asymptomatic pelvi – ureteric junction obstruction ( A-PUJO ) – is it safe ? – a cohort study

80 Journal of Clinical Urology 15(1) Of the 17 migrated stents, 9 were asymptomatic/incidentally found, 2 had LUTS/pain during elective follow-up. Six (35%) required emergency admission attributed to stent migration; two presented with significant pain, and four (24%) had significant complications. Of these significant complications, two had acute kidney injury and sepsis, one had sepsis with a psoas abscess, and one had fistulous leakage of urine. Within this subgroup, the median time to migration/complication was 26 days. Stent migration ultimately led to six cases requiring emergency treatment, five (29%) of which required emergency JJ stent/nephrostomy insertion. Conclusion: Allium ureteral stent migration may be associated with significant morbidity, often requiring emergency drainage of the kidney; our data suggest that these tend to occur within a month following stent insertion. P3 Initial experiences of starting a new regional extracorporeal shockwave lithotripsy (ESWL) service during a global pandemic Sam Crompton, Jodie Prynn, Jonathan Manley, Andrew Dickinson and Abigail Irish Department of Urology, Derriford Hospital, UK Introduction: The 2018 GIRFT report and 2019 NICE renal and ureteric stone guidelines recommended regional, fixed-site lithotripsy units to provide elective and emergency extracorporeal shockwave lithotripsy (ESWL) for urinary tract calculus <20 mm. In our region, Trusts were serviced by a mobile lithotripter, which was unable to provide adequate emergency treatment, as such a new fixedsite regional service was developed. Methods: The ongoing pandemic resulted in many challenges in the service development, including a reduction in urological operating by 25% during the COVID-19 pandemic, with additional loss of capacity as only patients ASA 2 or below was able to be treated in peripheral centres. A new pathway was introduced aiming to reduce admissions to surgical wards, instead moving directly to treatment and pain relief at home, in line with the 2019 NHS long-term plan. After 6 weeks of treating local patients, the service was opened to Trusts across the region to enable equal access for all patients’ for both emergency and elective ESWL. Results: In the first 6 months, 144 local stones were treated with ESWL (38 ureteric and 106 renal), of which 118 (81.9%) were successfully cleared, with the NICE guidelines quoting success rates between 72.4% and 83.8%. Across that period, this would have required 40 additional operating sessions (160 operative hours) to treat these stones ureteroscopically. With ureteroscopy £2347 more expensive than ESWL to get stone clearance (Constanti et al. BJUI 2020; 125: 457-466), the treatment cost saving in the first 6 months is £281,666. In addition, 53 stones were treated as an emergency from the region, with a stone clearance rate of 81% and 53% treated within 48 hours. Conclusion: The new ESWL service has resulted in regional stone treatments with success rates in line with published data, in addition to providing economic and operative capacity benefits during a global pandemic. P4 Ureteric stent insertion under local anaesthesia (LA): an effective, safe, and welltolerated alternative to general anaesthesia Cameron E Alexander, Jennifer Clark and Agapios Gkentzis Department of Urology, Royal Bolton Hospital, UK Background: The placement of ureteric stents under local anaesthesia (LA) offers the potential for an effective and safe alternative to general anaesthesia in the context of an increasingly co-morbid population and the ongoing COVID-19 pandemic. Objectives: (1) To assess the outcomes for patients with acute ureteric stones managed with the insertion of an emergency ureteric stent under LA. (2) To report the key procedural and logistical elements required to undertake successful LA stent placement. Methods: Patients presenting with CT confirmed, obstructing ureteric stones between 17/04/2020 and 06/07/2021 were included where insertion of an LA ureteric stent was undertaken as an emergency. The primary outcome was procedure success rate and secondary outcomes were serious post-procedure complication rate (defined as Clavien–Dindo ⩾ 3), time from CT diagnosis to stent placement, and patient tolerability (defined as pain from the procedure measured on a numerical rating scale 0–10, and reported concern regarding undergoing the same procedure in the future with the options of: no problem/minor problem/moderate problem/major problem). Results: Twenty-three patients underwent emergency LA ureteric stent placement for obstructing calculi with sepsis (73.9%, n = 17), uncontrolled pain (17.4%, n = 4) or acute kidney injury (8.7%, n = 2). The procedural success rate was 95.7% (n = 22/23), and the total number of serious complications was one (4.3%) (ureteric stent migration in duplex system). The median time from diagnosis to stent was 5.3 hours (interquartile range (IQR) = 16.3). The median pain score was 2 (IQR = 5.8), and most patients (73.9%, n = 17/23) reported they would have no problem or a minor problem undergoing the same procedure again. Conclusion: The placement of ureteric stents under LA represents an effective, safe, and well-tolerated alternative to general anaesthesia. The 24/7 availability of a flexible cystoscopy suite, C-arm, and fluoroscopy and specialist urology nurse within a dedicated urology unit has facilitated the delivery of this service.