Evaluation of the Hazards of Flexible Ureteroscope for the Treatment of Renal and Ureteral Calculi during the Learning Curve

Abstract
Background: Management of urolithiasis varies from simple clinical observation and medical expulsive therapy to the use of refined endourologic techniques to extract the stone. The therapeutic technique currently available comprises ureteroscopy with or without the need for intracorporeal lithotripsy, percutaneous therapy, (PCNL) Extracorporeal Shock Wave Lithotripsy (ESWL), and surgical modalities (4,5).
Objective: Urolithiasis (UL) is one of the most common diseases, with worldwide increasing incidence and prevalence.
Aim of the Work: Was to report the hazards of Flexible Ureteroscopy (FURS), the re-treatment rate and its complica-tion outcomes for the treatment of renal and ureteral calculi during the learning curve.
Patients and Methods: This study was conducted prospec-tively on forty patients divided into two groups; Group I (ureteric stone group) and Group II (renal stone group)to compare the complications after the introduction of FURS. They underwent FURS and Holmium: YAG laser lithotripsy. The complications were classified using modified stave and the Clavien system (I-IV).
Results: The mean patient age in the total procedures was 45.63±10.98 years (range 27.0-62.0 years), and the mean stone size was 1.36±0.37cm (range 0.6-2cm). Group I: Mean stone size 1.36±0.37cm, the stone free rate for all cases was 77.3% (100% for stones <1.5cm and 50% for stones ³1.5cm). The overall intra-operative complications rate in all cases was 27.2% (8.3% for stones <1.5 and 50% for stone size ³1.5cm). The overall post-operative complications rate was 27.4% (9% for stones <1.5cm and 60% for stones ³1.5cm.
Group II: The mean stone size 1.46±0.31, the stone free for all cases was 44.4% (70.0% for stones <1.5cm and 12.5%. for stones ³1.5cm. The overall intra-operative complications rate in all cases was 72.2% (52% for stones <1.5cm and 100% for stones size ³1.5cm. The overall post-operative complications rate was 77.7% (60% for stones <1.5cm and 100% for stones ³1.5cm was.
Conclusions: The results of the current study indicated that stone size, stone site and surgeon experience were factors affecting complication rates after FURS.