title: Low-cost semirigid ureteroscopy is effective for ureteral stones: experience of a single high volume center.
abstract: OBJECTIVE
  To demonstrate how, in a center with a large number of patients, as our center is, it is possible to perform ureterolithotripsy using a limited set of instruments.
  
  
  METHODS
  We evaluated medical charts of our center related to semirigid ureteral ureteroscopy (URS) with ureterolithotripsy using Holmium laser performed from July 2004 to July 2011. Overall, 658 URS for ureteral stones were performed in 601 patients, of which 204 in proximal ureter (31%), 86 in the mid (13.06%) and 368 (57.76%) in the distal ureter. In 504 patients (76.5%) ureterohydronephrosis (Grade II-III) was observed. In 57 patients (8.6%), we performed a bilateral approach at the same time, but most patients had a solitary distal ureteral stone. 106 patients (16.1%) had more than one stone in their distal ureter and 96 (14.8%) had a proximal ureteral stone treated in the same surgery as well.
  
  
  RESULTS
  The overall stone-free rate for ureteral stones was 86.1% (567/658). Success rates for proximal, medial and distal ureteral stones were 68.13% (139/204 patients), 84.8% (73/86 patients) and 96.4% (355/368 patients), respectively. One hundred and twenty patients (18.3%) required additional surgical treatment for their stones beyond the initial URS, including a second URS in 97 patients (14.74%) and URS plus Retrograde Intra-Renal Surgery (RIRS) in 23 patients (3.54%). The overall stonefree rate after the second treatment was 99.3%. Intra-operative complications accounted for 5.92% and consisted of ureteral perforations in 16 pts (2.4%), erosions of urothelium leading to significant bleeding in 15 pts (2.27%), severe pain in 4 pts (0.6%), fever in 3 pts (0.45%) and one case of ureteral avulsion (0.15%).
  
  
  CONCLUSIONS
  This study demonstrates that the use of Holmium laser lithotripsy is a safe and effective means of treating ureteral stones regardless of sex, age, stone location, or stone size. The instrumentation we used was extremely limited, in order to reduce costs related to the procedure to an absolute minimum whilst maintaining the two quality indicators for the procedure, namely success rate and length of hospitalisation (86.1% and 34 hours).
authors.affiliation: Division of Urology, Nuova Villa Claudia, Rome. giulianelli@virgilio.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Giulianelli
authors.forename: Barbara Cristina
authors.initials: BC
authors.lastname: Gentile
authors.forename: Giorgio
authors.initials: G
authors.lastname: Vincenti
authors.forename: Luca
authors.initials: L
authors.lastname: Mavilla
authors.forename: Luca
authors.initials: L
authors.lastname: Albanesi
authors.forename: Francesco
authors.initials: F
authors.lastname: Attisani
authors.forename: Gabriella
authors.initials: G
authors.lastname: Mirabile
authors.forename: Francesco
authors.initials: F
authors.lastname: Pisanti
authors.forename: Manlio
authors.initials: M
authors.lastname: Schettini
mesh_terms: D003365:Costs and Cost Analysis; D004867:Equipment Design; D006801:Humans; D008096:Lithotripsy; D014514:Ureteral Calculi / Q000628:therapy*; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000191:economics*