Ureteroscopy: Effect of technology and technique on clinical practice

Purpose: Technical advances in ureteroscopy allow for more aggressive management of upper tract pathology. We evaluate to what extent clinical practice and treatment efficacy have been impacted by improvements in technology and technique. Materials and Methods: In 1998, 176 consecutive patients underwent 182 ureteroscopic procedures at our institution. Retrospective chart review was performed. Factors such as clinical indication, pathology location, type of ureteroscope, procedure duration, procedure success, complication rate and length of stay were evaluated. Data from the 1998 cohort were compared to those obtained from a cohort of patients from 1992. Statistical analysis was performed using chi-square test. Results: Overall stone extraction rate was 94.4% (1992) vs 88.5% (1998) (p = 0.05). Proximal stones were treated in 13.5% (1998) vs 28.3% (1998) of cases. Distal stone extraction rate was 97.2% (1992) vs 95.1% (1998) (p = 0.43) and proximal stone extraction rate was 76.5% (1992) vs 71.9% (1998) (p = 0.73). Diagnostic inspection success rate was 98.3% (1992) vs 98.3% (1998). Use of flexible ureteroscopy was 11.5% (1992) vs 29.4% (1998). Complication rate was 12% (1992) vs 10.2% (1998) (p = 0.76). Of the cases 76.1% were outpatient in 1998 vs only 50% in 1992. Conclusions: Recent advances in ureteroscopic technology permit more aggressive instrumentation of the upper tract as reflected in higher use of flexible ureteroscopy and more frequent attempts to manage proximal ureteral calculi. These advances have not translated into better efficacy of calculus treatment. Furthermore, our data reflect a nationwide trend toward outpatient treatment.