title: A plea for centralized care for ureteroscopy: results from a comparative study under different conditions within the same center.
abstract: OBJECTIVE
  We stratified factors that affect treatment morbidity, compared the outcomes of ureteroscopy procedures from a single department under different conditions, and provided evidence of treatment benefits when ureteroscopy is performed in an expert setting.
  
  
  METHODS
  Since the department became a dedicated endourologic center in 2002, we grouped all ureteroscopy procedures into those performed before 2002 (group A) and after 2002 (group B). The modified Clavien classification was used to score morbidity. Independent variables with an influence on postoperative outcomes were studied, including operative time, intraoperative and postoperative complications, and hospitalization time.
  
  
  RESULTS
  Of the 248 ureteroscopy procedures performed, 62 comprised group A and 186 comprised group B. Statistical preoperative differences were in the American Society of Anesthesiologists score, patients with diabetes mellitus, cardiovascular disease, and the use of anticoagulants; and the perioperative differences were seen in operative time, hospital stay, and the number of eventful procedures. Group A had a significantly longer operative time and a longer hospital stay compared with group B. The number of failed and eventful procedures are also higher in group A compared with group B. Stone-free rates were similar in both groups.
  
  
  CONCLUSIONS
  The dedicated setting for ureteroscopy at our center resulted in decreased operative time, more uneventful procedures, and decreased hospitalization time. The modified Clavien morbidity score is a reliable tool for more objective comparisons of morbidity after ureteroscopic stone treatment.
authors.affiliation: Department of Urology, AMC University Hospital, Amsterdam, The Netherlands.
authors.forename: Jorge
authors.initials: J
authors.lastname: Rioja
authors.forename: Charalampos
authors.initials: C
authors.lastname: Mamoulakis
authors.forename: Hiren
authors.initials: H
authors.lastname: Sodha
authors.forename: Sven
authors.initials: S
authors.lastname: Suwijn
authors.forename: Pilar
authors.initials: P
authors.lastname: Laguna
authors.forename: Jean
authors.initials: J
authors.lastname: de la Rosette
mesh_terms: D002497:Centralized Hospital Services; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D013997:Time Factors; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000601:surgery; D018666:Ureteroscopy / Q000379:methods*