Flexible and rigid ureteroscopy in outpatient surgery

Abeni Oitchayomi, Arnaud Doerfler, Sophie Le Gal, Charles Chawhan, Xavier Tillou

Outpatient 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. A 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. Most 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). Flexible 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.