Learning curve of ureterorenoscopy for stones

ABSTRACT

The learning experience of URS in the first 155 patients [165 ureteral units] was evaluated as a therapeutic modality for stone retrieval. Using the rigid ureteroscope under flouroscopic control [in most of cases]; the overall success rate was [83.3%] [137 units], being successful on the first session in [74.5%] [123 units] and on the second session in [8.4%] [14 units], while the rest of units [13.3%] [23 units] respresent our failure rate. The highest success rate goes with the intramural stone 9 [90%]; pelvic stones 100 [85%]; while the iliac stones constituted 18 [75%] and lumbar stones 10 [55.5%]. Sorting our group chronologically we could not have a real rising curve for the first 50-60 units, but the actual rise was noticed in the subsequent 105 ureteral units. Complications reported in early procedures were in [60%] of units in comparison to [41%] in the subsequent ureteral units. We think that this relatively unsafe procedure is still a mandatory skill for every urologist to learn. Careful preoperative assessment of the ureteropyelogram, staging of the procedure; if impaction and/or stricture, antegrade approach for proximal stones, employing U.L whenever needed to avoid forcible manipulations, keeping the guide wire intraluminal all the time, close observations and follow up in the early postoperative week and thinking about the final status of the ureter rather than getting the stone out" are all among the most essential recommendations that should be considered thoroughly so as to minimise the drawbacks of the procedure