Introduction
Materials and methods
Pre-operative assessment
Use of an anaesthetic protocol
Surgical technique
Analysis of post-operative outcomes
Results
Day-case ureteroscopy
Patient demographics and clinical data (N = 544) |
n (%) ± SD |
---|---|
Male:female (n) | 347: 197 |
Mean age, years ± SD | 56 ± 16.3 |
Mean length of stay (days) ± SD | 0.49 ± 2.22 |
Day case | 424 (77.9) |
<24 h | 72 (13.2) |
1–3 days | 23 (4.2) |
>3 days | 25 (4.6) |
Positive pre-operative urine culture (treated appropriately), n (%) | 56 (10.3) |
Mean operative time (min) ± SD | 46.6 ± 25.5 |
Access sheath, (%) | 206 (38%) |
Size: 9.5/11.5, 10/12 | 78 (14.4) |
12/14 | 109 (20.2) |
14/16 | 11 (2.0) |
Not stated | 8 (1.5) |
Pre-operative stent, n (%) | 153 (28.1) |
Post-operative stent placement, n (%) | 523 (96.1) |
Stone-free rate, n (%) | 472/501 (94.2) |
LoS | Mean total stone length (mm) ± SD | No. of stones, n ± SD | Stone location, n (%) | |||
---|---|---|---|---|---|---|
Multiple locations | Renal | Ureteric | LP | |||
Day case, N = 424 | 14.0 ± 15.3 | 1.86 ± 2.24 | 106/424 (25) | 249/424 (58.7) | 180/424 (42.5) | 118/424 (27.8) |
<24 h, N = 72 | 14.9 ± 10.9 | 1.88 ± 2.27 | 19/72 (26.4) | 39/72 (54.2) | 39/72 (54.2) | 21/72 (29.2) |
1–3 days, N = 23 | 13.8 ± 11.9 | 2.36 ± 2.08 | 9/23 (39.1) | 17/23 (73.9) | 9/23 (39.1) | 10/23 (43.5) |
>3 days, N = 25 | 18.1 ± 34.3 | 3.13 ± 7.5 | 7/25 (28) | 10/25 (40) | 9/25 (36) | 5/25 (20) |
Total (%) | 141/544 (25.9) | 315/544 (57.9) | 237/544 (43.6) | 154/544 (28.3) |
LoS | M:F | Mean age (years) ± SD | LoS (days), mean ± SD | Positive urine culture (treated appropriately), n (%) | Pre-operative creatinine (μmol/L), mean ± SD | Pre-operative stent, n (%) |
---|---|---|---|---|---|---|
Day case, N = 424 | 284:140 | 56.0 ± 16.0 | N/A | 32/424 (7.5) | 87.5 ± 35.3 | 116/424 (27.4) |
<24 h, N = 72 | 38:34 | 57 ± 18.4 | N/A | 12/72 (16.7) | 101.3 ± 49.3 | 21/72 (29.2) |
1–3 days, N = 23 | 10:13 | 57 ± 11.1 | 2.04 ± 0.71 | 6/23 (26.1) | 88 ± 31.9 | 6/23 (26.1) |
>3 days, N = 25 | 15:10 | 68 ± 15.1 | 8.76 ± 5.72 | 6/25 (24) | 123.7 ± 85.8 | 10/25 (40) |
Failure of day-case ureteroscopy
<24 h, n (%) | 1–3 days, n (%) | >3 days, n (%) | |
---|---|---|---|
Factors resulting in failed day-case procedure (n = 99) | |||
Emergency admission with renal colic (n = 10) | 8 | 2 | |
Emergency admission with urosepsis (n = 6) | 2 | 3 | 1 |
Late completion of procedure (after 1500 h) (discharged the following morning) (n = 24) | 24 | ||
Social reasons (e.g. lives alone/frailty) (n = 23) | 13 | 6 | 4 |
Anaesthetic decision for admission (e.g. epilepsy, CPAP dependent) (n = 3) | 2 | 1 | |
Surgical decision for admission due to comorbidities (n = 5) | 4 | 1 | |
Surgical decision for admission due to previous history of urosepsis (n = 4) | 1 | 2 | 1 |
Elective post-operative catheterisation (n = 9) | 9 | ||
Post-operative pain/stent-related discomfort (n = 8) | 4 | 2 | 2 |
Other non-urological reasons (e.g. PEG feeding, cystic fibrosis, mental health issues, etc.) (n = 7) | 1 | 6 | |
Secondary to complications (22/544) (20—Clavien I–II, 1—Clavien III, 1—Clavien IV) | |||
a. Acute urinary retention | 1 | 2 | |
b. Sepsis | 1 | 8 | |
c. Urinary tract infection | 2 | 2 | |
d. Ureteric perforation | 1 | ||
e. Haematuria (not requiring transfusion) | 1 | ||
f. Post-operative vomiting/dehydration | 3 | 1 |
Complications
Re-admissions
Total number of patients re-admitted post-discharge <24 h (N = 496), n (%) | 20 (4%) |
---|---|
Reason for re-admission | |
Post-operative/stent-related pain | 9 |
Urinary tract infection | 4 |
Sepsis | 5 |
Haematuria (not requiring transfusion) | 2 |
Pre-operative, operative and stone characteristics
LoS | Mean operative time (min) ± SD | Access sheath, n (%) | Post-operative stent placement, n (%) | Stone free, n (%) |
---|---|---|---|---|
Day case | 43.4 ± 24.1 | 162/421 (38.5) | 409 (96.5) | 372/390 (95.4) |
<24 h | 57.9 ± 26.7 | 25/72 (34.7) | 68 (94.4) | 59/67 (88.1) |
1–3 days | 60 ± 33.7 | 9/23 (39.1) | 23 (100) | 18/21 (85.7) |
>3 days | 54 ± 22.8 | 10/25 (40) | 23 (92) | 23/23 (100) |
Overall | 206/544 (38%) | 523/544 (96%) | 472/501 (94%) |