Abstract
To assess the effect of our new classification on surgical outcomes after flexible ureteroscopy (fURS) for kidney stones. We retrospectively examined 128 patients after single renal fURS procedures performed using ureteral access sheaths (UASs) with the fragmentation technique. Based on the gap (calculated by subtracting the ureteroscope diameter from the UAS diameter), enrolled patients were divided into three groups: small (< 0.6mm), medium (0.6 to < 1.2mm), and large space groups (≥ 1.2mm). Stone-free (SF) status was defined as either complete absence of stones (SF) or the presence of stones < 4mm in diameter on non-contrast computed tomography (NCCT). The SF rate was significantly lower in the small space group (50% in small, 97.9% in medium, 89.2% in large; p = 0.001). Perioperative complications over Clavien-Dindo Grade I were observed in 16.7%, 4.2%, and 8.1% of patients, respectively (p = 0.452). The ratio of stone volume and operative time (efficiency of stone removal) was significantly higher in the large space group compared to the small and medium space groups (0.009 ± 0.003ml/min, 0.013 ± 0.005ml/min, 0.027 ± 0.012ml/min, respectively; p < 0.001). Our findings that gaps > 0.6mm (1.8 Fr), including the combination of a 9.5-Fr UAS and a small caliber ureteroscope, improve SF rates, and larger gaps facilitate stone removal efficiency providing the basis for future development of clinical protocols aimed at improving outcomes.
Published Version
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