title: Randomized trial of stone fragment active retrieval versus spontaneous passage during holmium laser lithotripsy for ureteral stones.
abstract: OBJECTIVE
  We assessed whether allowing spontaneous passage of small fragments is different from complete intraoperative extraction during semirigid ureteroscopy for ureteral stones.
  
  
  METHODS
  A total of 60 patients undergoing ureteroscopy and holmium laser lithotripsy were randomized to intraoperative fragment retrieval (group 1) or exhaustive lithotripsy and spontaneous fragment expulsion (group 2). The primary outcome was differences in unplanned medical and emergency room visits. Other outcomes were the rehospitalization, pain analgesia, time to complete recovery and 30-day stone-free rates.
  
  
  RESULTS
  Patients in group 1 were younger (47 vs 54 years, p = 0.05). Other characteristics, including stone burden and site, presentation mode, and ureteral dilation and stent placement rates, did not differ between the groups. Group 2 patients had a higher rate of unplanned visits (3% vs 30%, OR 12.4, 95% CI 1.8-80.3, p = 0.01), a trend toward higher rates of rehospitalization (0% vs 10%, p = 0.24) and the need for ancillary treatment (0% vs 7%, p = 0.49), and a lower stone-free rate (100% vs 87%, p = 0.1). Complications developed in 1 group 1 patient and in 2 in group 2, including 2 with postoperative fever and 1 with mucosal undermining of the guidewire.
  
  
  CONCLUSIONS
  Not actively retrieving fragments during semirigid ureteroscopy and holmium laser lithotripsy is associated with a higher risk of unplanned medical visits than complete intraoperative extraction. It also shows a tendency toward higher rates of rehospitalization, residual stones and the need for ancillary procedures.
authors.affiliation: Department of Urology, Chaim Sheba Medical Center, Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. oscar.schatloff@gmail.com
authors.forename: Oscar
authors.initials: O
authors.lastname: Schatloff
authors.forename: Uri
authors.initials: U
authors.lastname: Lindner
authors.forename: Jacob
authors.initials: J
authors.lastname: Ramon
authors.forename: Harry Z
authors.initials: HZ
authors.lastname: Winkler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D017602:Lithotripsy, Laser; D008875:Middle Aged; D011446:Prospective Studies; D016037:Single-Blind Method; D014514:Ureteral Calculi / Q000628:therapy*; D018666:Ureteroscopy; D055815:Young Adult