Predictors of success and hospitalization in semi-rigid ureteroscopy for lithiasis as an outpatient procedure.

OBJECTIVES: To analyze the outcomes, predictors of success and predictors of need for hospital admission in our series of patients who underwent ureteroscopy (URS) as a major outpatient surgery (MOS) procedure. METHODS: We carried out a retrospective analysis of 402 patients who had undergone semi-rigid URS for ureteral calculi as a MOS procedure in our center between 2004 and 2012. Patients with previous DJ catheter were excluded. We classified the calculi according to their location (lumbar, pelvic, iliac), size (< or> 1cm) and number (single or multiple). Follow-up was done by plain X-ray of the abdomen and ultrasound one month after surgery. The procedure was considered successful when patients were free from the treated calculi or had ureteral fragments < 3 mm one month after surgery. Univariate and multivariate analyses were carried out to identify the factors involved in success and hospitalization not being required. RESULTS: A total of 269 patients were included. The majority of the stones were single (92.2%), <1 cm in size (76.6%), pelvic (62.1%), and left-sided (57.2%). 89.6% of the procedures were performed as MOS and 82.2% were considered to be successful. In the multivariate analysis, left-sided (p<0.001) and pelvic location of the calculi (p=0,01) were found to be independent predictors for the success of the procedure In terms of hospital admission, the only independent predictor was the presence of intraoperative complications ( p=0.006). CONCLUSIONS: Left-sided and pelvic locations were the independent predictors for the success of the URS. A lack of intraoperative complications was the independent predictor for not requiring hospitalisation.

Factores predictores de éxito y necesidad de ingreso en la ureteroscopia semirigida en régimen ambulante / Predictors of success and hospitalization in semi-rigid ureteroscopy for lithiasis as an outpatient procedure

OBJETIVO: La ureteroscopia constituye una opción con elevadas tasas de éxito en el tratamiento de los cálculos ureterales, siendo superiores a la litotricia en la mayoría de los casos. El objetivo de nuestro trabajo es analizar las variables clínicas y demográficas, resultados y complicaciones, de nuestra serie de pacientes sometidos a ureteroscopia en régimen de cirugía mayor ambulatoria (CMA) y analizar los factores predictores de éxito del tratamiento y necesidad de ingreso hospitalario. MÉTODOS: Analizamos de forma retrospectiva 402 pacientes sometidos a ureteroscopia semirrígida (URS) por litiasis ureteral en régimen de CMA en nuestro centro entre 2004 y 2012. Excluimos los pacientes con catéter doble jota (CDJ) previo. Clasificamos las litiasis según su localización (lumbar, iliaca, pélvica) tamaño (< o > 1cm) y número (única o múltiple). El tratamiento se realizó mediante extracción con pinzas, LASER Holmium, o fragmentación mecánica. La revisión se realizó mediante radiografía simple de abdomen y ecografía al mes de la intervención. Consideramos éxito del procedimiento los pacientes libres del cálculo tratado o con restos litiásicos ureterales <3 mm al mes de la intervención. Realizamos un análisis univariante y multivariante mediante chi cuadrado y regresión logística para identificar los factores implicados en el éxito y la no necesidad de hospitalización. RESULTADOS: Incluimos 269 pacientes, 59% varones. La mayoría de la litiasis fueron únicas (92,2%), menores de un centímetro (76,6%), de localización pélvica (62,1%) e izquierdas (57,2%). Realizamos dilatación neumática del orificio ureteral en 67,3% de los casos, tratamos la mayoría de las litiasis con LASER (48%) y dejamos CDJ postoperatorio en el 92,2% de los casos. En el 83,3% de los procedimientos no existieron complicaciones intraoperatorias, realizándose el 89,6% en CMA, considerándolo éxito en el 82,2%. En el análisis multivariante, la lateralidad izquierda (p<0,001) y la localización pélvica de la litiasis (p=0,01) resultaron factores predictivos independientes de éxito del procedimiento. Para la necesidad de ingreso hospitalario solo la ausencia de complicaciones intraoperatorias resulto factor predictivo independiente (p=0,006). CONCLUSIONES: La lateralidad izquierda y la localización pélvica constituyen los factores predictores independientes de éxito de la URS. La ausencia de complicaciones intraoperatorias constituye el factor predictor independiente de no precisar hospitalización (AU)

OBJECTIVES: To analyze the outcomes, predictors of success and predictors of need for hospital admission in our series of patients who underwent ureteroscopy (URS) as a major outpatient surgery (MOS) procedure. METHODS: We carried out a retrospective analysis of 402 patients who had undergone semi-rigid URS for ureteral calculi as a MOS procedure in our center between 2004 and 2012. Patients with previous DJ catheter were excluded. We classified the calculi according to their location (lumbar, pelvic, iliac), size (< or > 1cm) and number (single or multiple). Follow-up was done by plain X-ray of the abdomen and ultrasound one month after surgery. The procedure was considered successful when patients were free from the treated calculi or had ureteral fragments <3 mm one month after surgery. Univariate and multivariate analyses were carried out to identify the factors involved in success and hospitalization not being required. RESULTS: A total of 269 patients were included. The majority of the stones were single (92.2%), <1 cm in size (76.6%), pelvic (62.1%), and left-sided (57.2%). 89.6% of the procedures were performed as MOS and 82.2% were considered to be successful. In the multivariate analysis, left-sided (p<0.001) and pelvic location of the calculi (p=0,01) were found to be independent predictors for the success of the procedure In terms of hospital admission, the only independent predictor was the presence of intraoperative complications (p=0.006). CONCLUSIONS: Left-sided and pelvic locations were the independent predictors for the success of the URS. A lack of intraoperative complications was the independent predictor for not requiring hospitalisation (AU)