Abstract
PurposeTo investigate the prospective outcomes of day-case ureterorenoscopy (DC-URS) for stone disease. With the rising prevalence of stone disease in the face of finite resources, there is increasing pressure to undertake procedures as a day case avoiding in-patient stay. There are a limited number of studies reporting on the feasibility of ureteroscopy as a day-case procedure. This study aimed to investigate the prospective outcomes and predictors precluding to DC-URS for stone disease in patients treated in our university teaching hospital.Materials and methodsBetween March 2012 and July 2016, consecutive cases of adult stone ureteroscopy performed or supervised by a single surgeon were recorded in a prospective database. Patients underwent pre-operative counselling in a specialist stone clinic and were admitted to a dedicated ‘Surgical day unit’ on the day of surgery. A standardised anaesthetic protocol was adhered to in all cases. Data on patient demographics, stone parameters, pre-operative assessment, operative details, length of stay, stone-free rate and complication rates were collected and analysed.ResultsA total of 544 consecutive adult ureteroscopy for stone disease were conducted over the study period with a day-case rate of 77.7%. Thirty-nine percent of failed day-case ureteroscopy were due to late completion of ureteroscopy and due to associated social circumstances of patients. The mean stone size, operating time duration and post-operative stent insertion rates for DC-URS patients were 14 mm, 46 min and 96.5%, respectively. Post-operatively, the mean stone-free rate (SFR), unplanned re-admissions and complications for DC-URS patients were 95, 4 and 4%, respectively. A higher failure of DC-URS was related to patient’s age (p = 0.003), positive pre-operative urine culture (p < 0.001), elevated pre-operative serum creatinine (p < 0.001) and higher mean operating time (p < 0.02).ConclusionBased on our results, a day-case ureteroscopy rate of nearly 78% can be achieved. With its acceptable complication rate, and low re-admission rates, DC-URS is a safe and feasible option in a majority of patients with stone disease.
Highlights
We are witnessing an ever increasing rise in the incidence of stone disease and with a lifetime prevalence of almost 14%, this has direct implications for patient morbidity and demand on healthcare resources [1, 2]
Data were collected for patient demographics, stone parameters, pre-operative assessment, operative details, length of stay (LoS), stone-free rate (SFR) and complication rates associated with the procedure
LoS was defined as the time from completion of URS to discharge of patients with day case defined as those patients discharged on the same day as having undergone the procedure
Summary
We are witnessing an ever increasing rise in the incidence of stone disease and with a lifetime prevalence of almost 14%, this has direct implications for patient morbidity and demand on healthcare resources [1, 2]. Being an endoscopic procedure with minimal risk of significant bleeding and a relatively short operating time, URS lends itself to being a suitable treatment modality as a daycase procedure, with studies demonstrating its feasibility as an outpatient procedure [8,9,10]. In the face of reduced resources, there is rising pressure for procedures to be undertaken on a day-case basis avoiding in-patient stay [1, 2]. The objective of this study is to investigate the prospective outcomes and predictors of failure of daycase URS (DC-URS) at our university teaching hospital
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