The Evolution of Ureteroscopy: A Modern Single-Institution Series

Krambeck, Amy E.; Murat, Francois J.; Gettman, Matthew T.; Chow, George K.; Patterson, David E.; Segura, Joseph W.
April 2006
Mayo Clinic Proceedings;Apr2006, Vol. 81 Issue 4, p468
Academic Journal
OBJECTIVES: To evaluate a modern ureteroscopy series, including the use of new technological advances, operative procedures, and potential complications, at a single institution and to compare our current experience with our prior published series and the current literature. MATERIAL AND METHODS: We retrospectively reviewed 1000 consecutive ureteroscopies performed in 961 patients from December 1999 to February 2003 at our institution. RESULTS: Semirigid and flexible ureteroscopes were used in 60.3% and 37.0% of the cases, respectively. In 2.6% of cases, a combination of both rigid and flexible ureteroscopes was required. The most common indications for ureteroscopy were as follows: stone, 57.9%; diagnostic, 20.6%; and urothelial carcinoma, 12.6%. Of the stones treated, 31.8% were proximal or middle and 59.1% distal. The overall, proximal, and distal stone-free rates were 91.7%, 87.3%, and 94.2%, respectively. Average operative time was 81 minutes (range, 5.280 minutes). Average follow-up was 2.36 months (range, 1-24 months). The overall complication rate was 1.9% (18/961), Including a 0.2% (2/961) incidence of ureteral strictures. CONCLUSION: Current practice trends have shifted to an increased use of flexible ureteroscopes and more frequent ureteroscopic treatment of proximal calculi. Our single treatment stone-free rates are competitive with quoted shock wave lithotripsy success. in addition, there has been a decrease in ureteroscopic-associated complications In our series, with no ureteral avulsions. The improvements in treatment success and decrease in complications may be secondary to advances in ureteroscopic technology.


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