Is traditional stone clinic the optimal use of NHS resources?

There is no clear guidance on the efficacy of stone follow-up. NICE have been unable to make recommendations with current published evidence. The aim of this study was to understand the patient journey resulting in surgical intervention, and whether traditional stone follow-up is effective. A retrospective review of patients undergoing ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) over a 3 year period identified 471 patients who underwent these procedures to treat stone disease. Records were interrogated for the following: symptoms, mechanism of booking, reason for intervention, stone size, stone location, risk factors and previous follow-up. Of 471 patients who underwent intervention, 168 were booked from stone clinic follow-up (36%). Of these, 96% were symptomatic and 4% were asymptomatic. When risk factors were removed, this figure was reduced to 1%. Sepsis rate for emergency admissions differs between those followed up (13%) versus new presentations (19)%. There was no statistically significant difference in the outpatient imaging frequency between patients booked from an emergency admission (80% having imaging every 6 months) and those from the clinic (82%). Our Hospital provides on average 650 stone clinic appointments a year with a cost of £93,000. Given the low rate of intervention in patients with asymptomatic renal stones, a symptomatic, direct-access emergency stone clinic could be a better model of care and use of NHS resources. Urgent research is required in this area to further assess if this is the case.