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

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

PURPOSE: To investigate the prospective outcomes of day-case ureterorenoscopy (DC-URS) for stone disease. With the rising prevalence of stone disease in the face of finite resources, there is increasing pressure to undertake procedures as a day case avoiding in-patient stay. There are a limited number of studies reporting on the feasibility of ureteroscopy as a day-case procedure. This study aimed to investigate the prospective outcomes and predictors precluding to DC-URS for stone disease in patients treated in our university teaching hospital.

MATERIALS AND METHODS: Between March 2012 and July 2016, consecutive cases of adult stone ureteroscopy performed or supervised by a single surgeon were recorded in a prospective database. Patients underwent pre-operative counselling in a specialist stone clinic and were admitted to a dedicated 'Surgical day unit' on the day of surgery. A standardised anaesthetic protocol was adhered to in all cases. Data on patient demographics, stone parameters, pre-operative assessment, operative details, length of stay, stone-free rate and complication rates were collected and analysed.

RESULTS: A total of 544 consecutive adult ureteroscopy for stone disease were conducted over the study period with a day-case rate of 77.7%. Thirty-nine percent of failed day-case ureteroscopy were due to late completion of ureteroscopy and due to associated social circumstances of patients. The mean stone size, operating time duration and post-operative stent insertion rates for DC-URS patients were 14 mm, 46 min and 96.5%, respectively. Post-operatively, the mean stone-free rate (SFR), unplanned re-admissions and complications for DC-URS patients were 95, 4 and 4%, respectively. A higher failure of DC-URS was related to patient's age (p = 0.003), positive pre-operative urine culture (p < 0.001), elevated pre-operative serum creatinine (p < 0.001) and higher mean operating time (p < 0.02).

CONCLUSION: Based on our results, a day-case ureteroscopy rate of nearly 78% can be achieved. With its acceptable complication rate, and low re-admission rates, DC-URS is a safe and feasible option in a majority of patients with stone disease.

Journal Article
0724-4983
1757-1764
Ghosh, Anngona
3c5a161a-32d1-4285-b740-5db138f9610d
Oliver, Rachel
82bdb18f-52f3-4fef-9968-c8d58acaca76
Way, Carolyn
2083acd3-eafe-4952-9c17-1f16c2ee25e7
White, Lucy
894d1733-4abc-4d0e-9c60-a6e6088f8829
Somani, Bhaskar K.
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Ghosh, Anngona
3c5a161a-32d1-4285-b740-5db138f9610d
Oliver, Rachel
82bdb18f-52f3-4fef-9968-c8d58acaca76
Way, Carolyn
2083acd3-eafe-4952-9c17-1f16c2ee25e7
White, Lucy
894d1733-4abc-4d0e-9c60-a6e6088f8829
Somani, Bhaskar K.
ab5fd1ce-02df-4b88-b25e-8ece396335d9

Ghosh, Anngona, Oliver, Rachel, Way, Carolyn, White, Lucy and Somani, Bhaskar K. (2017) Results of day-case ureterorenoscopy (DC-URS) for stone disease: prospective outcomes over 4.5 years. World Journal of Urology, 35 (11), 1757-1764. (doi:10.1007/s00345-017-2061-1).

Record type: Article

Abstract

PURPOSE: To investigate the prospective outcomes of day-case ureterorenoscopy (DC-URS) for stone disease. With the rising prevalence of stone disease in the face of finite resources, there is increasing pressure to undertake procedures as a day case avoiding in-patient stay. There are a limited number of studies reporting on the feasibility of ureteroscopy as a day-case procedure. This study aimed to investigate the prospective outcomes and predictors precluding to DC-URS for stone disease in patients treated in our university teaching hospital.

MATERIALS AND METHODS: Between March 2012 and July 2016, consecutive cases of adult stone ureteroscopy performed or supervised by a single surgeon were recorded in a prospective database. Patients underwent pre-operative counselling in a specialist stone clinic and were admitted to a dedicated 'Surgical day unit' on the day of surgery. A standardised anaesthetic protocol was adhered to in all cases. Data on patient demographics, stone parameters, pre-operative assessment, operative details, length of stay, stone-free rate and complication rates were collected and analysed.

RESULTS: A total of 544 consecutive adult ureteroscopy for stone disease were conducted over the study period with a day-case rate of 77.7%. Thirty-nine percent of failed day-case ureteroscopy were due to late completion of ureteroscopy and due to associated social circumstances of patients. The mean stone size, operating time duration and post-operative stent insertion rates for DC-URS patients were 14 mm, 46 min and 96.5%, respectively. Post-operatively, the mean stone-free rate (SFR), unplanned re-admissions and complications for DC-URS patients were 95, 4 and 4%, respectively. A higher failure of DC-URS was related to patient's age (p = 0.003), positive pre-operative urine culture (p < 0.001), elevated pre-operative serum creatinine (p < 0.001) and higher mean operating time (p < 0.02).

CONCLUSION: Based on our results, a day-case ureteroscopy rate of nearly 78% can be achieved. With its acceptable complication rate, and low re-admission rates, DC-URS is a safe and feasible option in a majority of patients with stone disease.

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More information

Accepted/In Press date: 8 June 2017
e-pub ahead of print date: 15 June 2017
Published date: 1 November 2017
Keywords: Journal Article

Identifiers

Local EPrints ID: 418990
URI: http://eprints.soton.ac.uk/id/eprint/418990
ISSN: 0724-4983
PURE UUID: 8196cea4-49af-4941-a552-2f913f76f922

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Date deposited: 27 Mar 2018 16:30
Last modified: 15 Mar 2024 19:01

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Contributors

Author: Anngona Ghosh
Author: Rachel Oliver
Author: Carolyn Way
Author: Lucy White

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