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We previously showed that nearly half the patients left with residual fragments (RFs) after URS experience a subsequent stone-related event (SE). We aimed to determine if a stone free state after URS is associated with a fewer SEs than those left with residual fragments.METHODS: After undergoing URS for renal and ureteral calculi between December 2015 and February 2017 167 patients (209 renal units, RUs) were prospectively enrolled. CT was obtained 6-8 weeks post-operatively. Patients were evaluated at subsequent office visits and/or contacted by phone to determine if a stone event attributable to the treated RU occurred. A stone event (SE) was defined as spontaneous stone passage, symptoms requiring emergency department (ED) visit, surgical intervention, or stone growth. Only patients with at least 12 months of follow-up were included for analysis. Kaplan Meier analysis, Chi-squared analysis, log rank test, and logistic regression were used to assess outcomes.RESULTS: Among the study group, 123 patients and 152 RUs met study criteria, including 57% (87 RUs) with residual fragments and 43% (65 RUs) who were rendered stone-free on post URS CT. Median overall follow-up was 29 months . The mean number of RFs per patient was 2.1 AE 1.5 and mean largest fragment size was 3.7 AE 2.0 mm. SE occurred in 47% (41/87) of RUs with RFs and 14% (9/ 65) of those that were stone free (p<0.001). Median time to SE was 33 months for those with RFs (CI 23-43) and 45 months in those who were stone free . The stone event-free survival was 68% in those with RFs and 98% in those stone free at 24 months (p<0.001) (Figure 1). Multivariate regression demonstrated stone-free status as a predictor of a stone event (OR 4.98, p<0.001), although residual fragment size and number were not.CONCLUSIONS: Attaining a stone-free state after URS with basket extraction reduces the rate of SEs in patients undergoing ureteroscopy.

We report our experience in setting up a urological laser unit. An operating theatre was upgraded to include the required safety features and a neodymium-YAG laser was installed. A preliminary study using cadaver bladders was performed to establish the technique of cystoscopic laser application. We treated 55 bladder tumours in 12 patients by laser coagulation, with total destruction of 54 tumours and no serious complications; 6 patients developed recurrent tumours. Twenty-one patients underwent surgery with the contact laser scalpel. The instrument proved slow but effective, with excellent haemostasis and almost painless wounds. Healing was delayed in 2 cases but there were no wound infections. All wounds healed with good cosmetic scars. The neodymium-YAG laser is an effective means of destroying superficial non-invasive bladder tumours endoscopically and can also be used in conjunction with a laser scalpel for open surgery.

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