title: Outpatient holmium laser lithotripsy using semirigid ureteroscope. Is the treatment outcome affected by stone load?
abstract: OBJECTIVE
  To compare the outcome of outpatient ureteroscopic laser lithotripsy (URSL) for ureteral stone larger than 10 mm in longest diameter (group 1) with those less than or equal to 10 mm (group 2).
  
  
  METHODS
  134 patients with solitary ureteral stone were treated by outpatient URSL. No exclusion criteria with regards to stone size, level or composition were applied. Semirigid ureteroscopy and holmium-YAG laser lithotripsy was performed under general anaesthesia as outpatient procedure. Radiological follow-up by intravenous urogram was performed 3 months postoperatively. Patients' demographic data, stone parameters, operative details and treatment outcome were collected prospectively and compared between the two groups.
  
  
  RESULTS
  Among the 134 ureteral stones, 41(31%) were larger than 10 mm. Group 1 contained more upper and middle ureteral stones than group 2 (68 vs. 40% p = 0.001). Operating time was significantly longer for group 1 (68.9 vs. 46.8 min, p<0.001) and postoperative stenting rate was higher (83 vs. 60%, p = 0.01). There was no difference between the groups in terms of 3 months stone clearance rate (92.7 vs. 91.4%, p = 0.8). Complication rate was higher in group 1 (22 vs. 5.4%, p = 0.004) especially for lower stones (46.2 vs. 5.4%, p = 0.001) but most of which were minor complications that were treated conservatively. One patient in group 1 (2.4%) developed ureteral stricture at the longstanding stone impaction site despite postoperative stenting. The stricture resolved subsequent to balloon dilatation.
  
  
  CONCLUSIONS
  URSL can treat stones larger than 10 mm in longest diameter at all levels safely and effectively in an outpatient setting.
authors.affiliation: Division of Urology, Department of Surgery, Tung Wah Hospital, The University of Hong Kong, Hong Kong. mccheunguro@aol.com
authors.forename: M C
authors.initials: MC
authors.lastname: Cheung
authors.forename: F
authors.initials: F
authors.lastname: Lee
authors.forename: S K
authors.initials: SK
authors.lastname: Yip
authors.forename: P C
authors.initials: PC
authors.lastname: Tam
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D005240:Feasibility Studies; D005260:Female; D006695:Holmium / Q000627:therapeutic use*; D006801:Humans; D017602:Lithotripsy, Laser; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000473:pathology* / Q000628:therapy*; D020709:Ureteroscopes
chemical_list: D006695:Holmium