[Initial experience of first 225 flexible ureteroscopy with laser lithotripsy in a primary care hospital].
BACKGROUND
During the last decade, the advent of flexible ureteroscopy with laser lithotripsy has revolutionized the management of upper urinary tract stones. Our center is a primary care hospital that is equipped with this technology since January 2011. This study reported our initial experience of first 225 cases.


METHODS
This study is a descriptive, retrospective and monocentric analysis. The first 225 cases, operated consecutively by 3 surgeons during 26 months, were analyzed. We have used 2 flexible ureteroscopes (1 digital, 1 optical). Laser source was an Holmium laser (Stonelight) at a power of 5 watts.


RESULTS
The mean age was 53 years (± 10.2) and the mean stones size was 11 mm (2.3). In 49% of cases, ureteroscopy was chosen for the first, without prior treatment. In 59% of cases, ureteroscopy was used after failure of other treatment (ESWL in 70% of cases). The mean operative time was 72 minutes (± 16.6) and the mean length of stay was 2.6 days (± 0.8). The first session of ureteroscopy was a success in 93% of cases without residual fragments after 1 month. The frequency of postoperative complications was estimated at 8% (Clavien I and II).


CONCLUSIONS
Flexible ureteroscopy with laser lithotripsy was a safe and effective technique, allowing the treatment of all upper urinary tract stones, especially on failure of other treatment. Its place in the first intention is widespread in our exercise, especially among obese patients, patients on anticoagulant therapy or with stone of the lower pole.
Service d'urologie, centre hospitalier de Lunéville, 2, rue Level, 54301 Luneville, France; Service d'urologie, hôpitaux de Brabois, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France. Electronic address: etiennebarbier1@gmail.com.
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E
Barbier
Service d'urologie, centre hospitalier de Lunéville, 2, rue Level, 54301 Luneville, France.
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M
Statoua
Service d'urologie, centre hospitalier de Lunéville, 2, rue Level, 54301 Luneville, France.
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A
Mazdar
Service d'urologie, centre hospitalier de Lunéville, 2, rue Level, 54301 Luneville, France.
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D
Hollard
Service d'urologie, centre hospitalier de Lunéville, 2, rue Level, 54301 Luneville, France; Service d'urologie, hôpitaux de Brabois, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
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F
Houndete
Service d'urologie, hôpitaux de Brabois, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
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J
Hubert
D004867:Equipment Design; D005260:Female; D006761:Hospitals; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D017602:Lithotripsy, Laser; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012189:Retrospective Studies; D014514:Ureteral Calculi / Q000628:therapy*; D020709:Ureteroscopes; D018666:Ureteroscopy
Flexible ureteroscopy; Haut appareil urinaire; Holmium laser; Laser Holmium; Lithiase; Stone disease; Upper urinary tract; Urétéroscopie souple