Does size of semi-rigid ureteroscope make any difference in the management of ureteric stones in adult patients?

Abstract

Background:Ureteroscopic lithotripsy is the standard of treatment for ureteric stones. Varying size of ureteroscopes provide their own advantages and drawbacks. We explored this issue further in our study by comparing outcomes of two different sized ureteroscopes.Methods: Forty adult patients of ureteric stones of Indian origin were taken. They were divided into two groups. Group A utilized 6.4/7.8Fr ureteroscope; while group B used 8.6/9.8Fr ureteroscope. Baseline demographic, clinical and stone parameters were compared. Outcome was assessed in form of stone free rate (SFR), operative time, hospital stay and occurrence of perioperative complications. Student-T and Chi-square tests were used in analysis.Results:Mean age and BMI were 42.1±13.9 years and 28.6±4.3. Both groups were comparable in age (p=.446), gender (p=.592), BMI (p=.453), stone size (p=.512), side (p=.393) and location (p=.387). Operation time was high in group A (38.8 ± 13.0 v/s 33.8 ± 6.8), while hospital stay was similar among groups (p=.878). Replacement of ureteroscope was more in group B (8/21 v/s 4/19). SFR in group A and B without ureteroscope exchange was 73.7% and 57.1%; while replacement improved SFR to 84.2% and 90.5% respectively (p=.000). SATAVA intraoperative complications were modestly high in group B. Occurrence of Clavien-Dindo postoperative complications were also similar (p=.672).Conclusion:Small ureteroscope was better in a narrow or proximal ureter, while large size offered better vision with quick stone clearance. Though complications were slightly high with large caliber ureteroscope, most were of low grades. Replacement to other size in difficult situations ensures best SFR.