Day surgery urolithiasis management: efficacy and safety of ureteroscopy and laser lithotripsy in a district general hospital setting

Abstract

Introduction: Incidence of urolithiasis is rising worldwide and increasingly Ureteroscopy (URS) coupled with laser fragmentation is being used safely within the day surgery setting for ureteral and renal stone management. This study is to explore whether URS guided lithotripsy could be delivered effectively as a day surgery procedure. Method: Retrospective analysis of 118 day surgery patients who underwent URS guided laser lithotripsy for ureteric and renal calculi between November 2017 and April 2019. All patients underwent ureteric stenting during acute admission prior to the URS guided lithotripsy. Outcomes were compared against European Association of Urology (EAU) guidelines on the best clinical practice in use of URS in urolithiasis. Results: Of the 118 patients who underwent URS and laser fragmentation, mean age was 54 years with 2:1 male:female ratio. 56% were ureteric (67% upper, 8% middle and 25% distal ureter), 44% renal stones. Mean stone size was 9.7mm, with 58% ‹1cm, 38% 1-2cm and 4% ›2cm. 90.6% of patients following URS guided stone fragmentation were stone-free. The complication rate was 8.5% (n = 10), Clavien-dindo 3 in 4 patients and Clavien-dindo 4 in 1 patient. Conclusion: This study demonstrated that URS guided stone fragmentation can safely deliver high stone free and low complication rates within day surgery setting.