Day‐case ureteroscopy: an observational study

Abstract

Objective To evaluate the outcome after day-case ureteroscopy (used in diagnosing and managing ureteric disease, primarily urolithiasis), as awareness of reduced resources has resulted in increasing pressure to undertake procedures in a day-surgery setting. Patients and methods All patients presenting to the unit and requiring ureteroscopy between May 1995 and May 2000 were considered for a day-surgery procedure. The assessment of suitability comprised anaesthetic and social factors; no urological criteria precluded a day-surgery procedure. Outcomes after day-case ureteroscopy, including immediate or delayed admissions and subsequent inpatient management, were reviewed retrospectively. Results Sixty-three day-case ureteroscopies were performed on 56 patients (mean age 47 years, range 19±78); eight procedures were diagnostic. Therapeutic ureteroscopies included one balloon dilatation of a ureteric stricture and 54 procedures for urolithiasis, with 98% stone clearance. Most patients were discharged with a JJ stent in situ. Of nine patients requiring immediate admission, seven were for pain control; eight were discharged on the following day. Seven patients required delayed admission 1±13 days after the procedure, three for stent-related symptoms and three for infection. No signi®cant predictors of immediate or delayed admission were identi®ed, although antibiotic prophylaxis was associated with a reduced admission rate. Conclusion Ureteroscopy can be used successfully as a planned day-case procedure in a dedicated daysurgery unit, with few patients requiring hospitalization. Implementation of analgesia protocols and routine antibiotic prophylaxis may reduce admission after day-case ureteroscopy.

Day-Case Rigid and Flexible Ureteroscopy

“…Of patients in our study, 34% were stented post procedure compared with 81% in a previous study. 2 This lower rate of stent insertion produced no admissions with sepsis or stent symptoms. The role of stent insertion after therapeutic ureteroscopy is controversial and has changed with the evolution of the technique.…”

“…Taylor et al 2 had an unplanned admission rate of 25%. The immediate admissions were predominantly for pain and the delayed admissions for stent symptoms and infection.…”

“…Taylor et al 2 retrospectively reviewed rigid ureteroscopy. In our study, we have prospectively examined both rigid and flexible ureteroscopy in the day-surgery setting.…”

“…Taylor et al 2 quote a 98% stone clearance rate for predominantly mid and distal ureteric stones; 8% of stones treated were in the upper ureter. These clearance levels are consistent with other published data.…”

“…1 Taylor et al, 2 in a retrospective study evaluating the outcome of rigid ureteroscopy in the day-case, setting showed a 26% admission rate, but a 98% stone clearance with 56% of stones being in the distal ureter. These are the only data from ureteroscopic procedures performed in a dedicated day-surgery setting.…”