title: The evolution of ureteroscopy: a modern single-institution series.
abstract: OBJECTIVE
  To evaluate a modern ureteroscopy series, including the use of new technological advances, operative procedures, and potential complications, at a single institution and to compare our current experience with our prior published series and the current literature.
  
  
  METHODS
  We retrospectively reviewed 1000 consecutive ureteroscopies performed in 961 patients from December 1999 to February 2003 at our institution.
  
  
  RESULTS
  Semirigid and flexible ureteroscopes were used in 60.3% and 37.0% of the cases, respectively. In 2.6% of cases, a combination of both rigid and flexible ureteroscopes was required. The most common indications for ureteroscopy were as follows: stone, 57.9%; diagnostic, 20.6%; and urothelial carcinoma, 12.6%. Of the stones treated, 31.8% were proximal or middle and 59.1% distal. The overall, proximal, and distal stone-free rates were 91.7%, 87.3%, and 94.2%, respectively. Average operative time was 81 minutes (range, 5-280 minutes). Average follow-up was 2.36 months (range, 1-24 months). The overall complication rate was 1.9% (18/961), including a 0.2% (2/961) incidence of ureteral strictures.
  
  
  CONCLUSIONS
  Current practice trends have shifted to an increased use of flexible ureteroscopes and more frequent ureteroscopic treatment of proximal calculi. Our single treatment stone-free rates are competitive with quoted shock wave lithotripsy success. In addition, there has been a decrease in ureteroscopic-associated complications in our series, with no ureteral avulsions. The improvements in treatment success and decrease in complications may be secondary to advances in ureteroscopic technology.
authors.affiliation: Department of Urology, Mayo Clinic College of Medicine, Rochesterr, MN 55905, USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Krambeck
authors.forename: Francois J
authors.initials: FJ
authors.lastname: Murat
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Gettman
authors.forename: George K
authors.initials: GK
authors.lastname: Chow
authors.forename: David E
authors.initials: DE
authors.lastname: Patterson
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Segura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014515:Ureteral Diseases / Q000175:diagnosis*; D020709:Ureteroscopes / Q000639:trends; D018666:Ureteroscopy / Q000639:trends*