Ureteroscopic treatment of urolithiasis: How do we measure and optimise outcomes?

Abstract

Background: Patients with urolithiasis have access to a wide range of efficacious therapeutic surgical options, including shockwave lithotripsy (SWL), retrograde ureteric or intrarenal surgery with semi-rigid and flexible ureteroscopes (URS or fURS) and percutaneous nephrolithotomy (PCNL). In recent years, there have been many peer-reviewed publications evaluating new techniques and new equipment, such as pulse-modulated Holmium:YAG and thulium fibre lasers. However, when reviewing this extensive literature, it becomes apparent that there is no consensus on what constitutes a ‘successful’ stone treatment outcome. Objectives: The purpose of this article is to review the existing measures of ‘success’ after the ureteroscopic treatment of urolithiasis and to promote a standardised and holistic approach to reporting outcomes in clinical trials. Methods: Our narrative review focussed on studies examining measures of success in urolithiasis treatment published within the last 10 years. Conclusions: Due to markedly different reported outcome measures of treatments for urolithiasis, comparing results between studies can be difficult. In addition to measuring clinical outcomes, there is an increasing acknowledgement of the importance of patient-reported outcome measures (PROMs) in determining treatment success, and the need to consider the cost-effectiveness and environmental sustainability of various treatments. We suggest that all future studies on this common urological condition should incorporate holistic and tranpsarent outcome measures. Level of evidence: Not applicable