Flexible and rigid ureteroscopy in outpatient surgery

Abstract

BackgroundOutpatient surgery is critical to improve health care costs. The aim of the study was to prospectively evaluate the results of outpatient treatment of upper tract urinary stones by rigid or flexible ureteroscopy in a routine care setting.MethodsA database was created at the creation of the outpatient surgery department. 87 patients underwent 100 ureteroscopic procedures for urinary lithiasis from June 2013 to March 2015.ResultsMost of our patients were male with 53 men (sex ratio M/F 1.13), with a mean age of 52.9 ± 15 years old (23.4–82.4). 44 % of ureteroscopies performed were flexible ureteroscopies, 31 % rigid ureteroscopies and 25 % associated rigid and flexible ureteroscopies. The average stone load was 10.1 ± 5.7 mm (2–30) The mean operating time was 58.3 ± 21.1 min (20–150). 82.9 % of patients had a single urinary stone and 17.1 % (n = 14) had 2 or more. 114 stones were treated, 57,1 % intrarenal. There were 6 (6 %) postoperative complications: three Clavien stage 2 infections; three Clavien stage 3b complications (two renal colics requiring ureteral stenting 48 h after discharge and 1 symptomatic perirenal urinoma 48 h after discharge). There was one intraoperative complication (1 %): a ureteral wound with contrast leakage. The rate of transfer to conventional hospitalization was 2.2 %. Stone size influenced the stone-free status (p < 0.0001) and the need for more than one session. There was a significant correlation between operative time and stone size above 10 mm (p < 0.0001).ConclusionsFlexible and rigid ureteroscopy are safe and efficient procedures for upper urinary tract stones and can be carried out in an outpatient department. Stone size had an impact on postoperative stone-free status and operative time.

Predictors of Hospitalization After Ureteroscopy Plus Elective Double-J Stent as an Outpatient Procedure

“…Moreover, including patients with ASA score III could also explain a relative high percentage of unplanned admission in our series (9%). Indeed excluding patients with ASA III score in our analysis leads to a decreased rate of hospitalization (from 9 to 5%) that is comparable to previous experiences [14,15,20] in which only patients with ASA score I-II were evaluated. Therefore, on the basis of our results, we discourage to manage patients with ASA III score in an outpatient setting, especially if a long operative time (p = 0.018) can be expected.…”

“…The recent advances in anesthetic techniques have progressively led many surgical procedures to be performed on an outpatient basis extending the types of patients that can be performed on an outpatient basis: For example, the guidelines of the ASA and other anesthesiological societies confirm that stable and controlled ASA III or IV is not an absolute contraindication for outpatient surgery for different surgical procedures [18,19]. Comparing with previous retrospective experiences [15,20], we believe that the strength of our methods has been to include in the analysis patients with ASA III score and other general factors like comorbidities or body mass index, so to better define the right population for URS in a day surgery. In our analysis, only the ASA score was independently associated (p < 0.01) with hospitalization with 44% of patients with ASA score III who have been admitted to inpatient ward.…”

Analysis of Prestenting on Outcomes of Flexible Ureteroscopy for Upper Urinary Urolithiasis: A Historical Control Study

“…It is recommended as a good option for upper urinary stone less than 2 cm due to its efficacy and safety [1]. Even some outpatient surgeries have been proven to be effective and safe [2]. Prestenting (PS) of fURS does not seem to be a controversial topic because guidelines suggest routinely performed PS is not necessary before fURS and recommended only in challenging cases [1].…”

Results of day-case ureterorenoscopy (DC-URS) for stone disease: prospective outcomes over 4.5 years

“…However, despite a number of studies suggesting that it can be conducted in an outpatient setting, reports of its safety and efficacy as a true day-case procedure are limited [ 8 – 10 , 13 ]. Studies with URS have predominantly been conducted in the setting of an in-patient hospitalisation or patients undergoing the procedure with overnight stay and therefore not true day cases [ 14 , 15 ]. To our knowledge, no large series have investigated the outcomes and predictors for failure of day-case URS.…”

“…In our results, we did not find a significant difference in the LoS for different stone locations (renal versus ureteric). Oitchayomi et al recently reported that URS can be safely and effectively performed for upper urinary tract stones in the outpatient setting [ 15 ]. To date, studies have failed to show differences in complication rates for stone location post-URS [ 23 – 27 ].…”