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Inicio Actas Urológicas Españolas (English Edition) Initial results of endourological treatment of renoureteral lithiasis by means o...
Journal Information
Vol. 47. Issue 1.
Pages 15-21 (January - February 2023)
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Vol. 47. Issue 1.
Pages 15-21 (January - February 2023)
Original article
Initial results of endourological treatment of renoureteral lithiasis by means of flexible ureteroscopy and percutaneous surgery in an outpatient procedure in a tertiary care center
Resultados iniciales del tratamiento endourológico de la litiasis renoureteral mediante ureteroscopia flexible y cirugía percutánea en régimen de cirugía mayor ambulatoria en un centro de tercer nivel
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M.E. Martínez-Corrala,
Corresponding author
memartinezc92@gmail.com

Corresponding author.
, J.J. Núñez-Oteroa, C. Fernández-Baltara, A. Masid-Gómezb, C. Valiño-Hortasb, D. Pérez-Fentesa
a Unidad de Endourología y Litiasis, Servicio de Urología, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
b Unidad de Cirugía Ambulatoria, Servicio de Anestesia y Reanimación, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
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Tables (4)
Table 1. Demographic characteristics of the patients in the series (n = 85).
Table 2. Main characteristics of the procedures performed and results (n = 85).
Table 3. Main series of ambulatory semi-rigid and flexible ureteroscopy in the literature.
Table 4. Results of the main publications on ambulatory percutaneous nephrolithotomy.
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Abstract
Objective

Urinary lithiasis is a prevalent disease with a high socioeconomic impact, where endourological surgery has shown excellent results with minimal complications. For its part, outpatient surgery is an efficient, safe and quality care model. We present our experience in the outpatient endourological treatment of lithiasis and a review of the main series.

Material and methods

Prospective analysis of 85 flexible or percutaneous procedures for the treatment of lithiasis, carried out in our center between January 2021 and April 2022. The main objective was to analyze the rate of unplanned admission and the success and incidence of complications as secondary objectives. The patients were selected following the inclusion criteria of the care process.

Results

The mean age was 56 ± 14 years. Urine culture was positive in 13.9% of the patients, 38% had a pre-surgical double-J catheter. Median stone surface was 55 mm 2 (961 ± 323 Hounsfield Units). 73 flexible and 12 percutaneous procedures were performed. 8 patients required immediate unplanned admission and another 2 during the first month. 94% were stone-free at the third month. No intraoperative complications were detected, although 16.5% of the patients presented some type of postoperative complication.

Conclusion

In our experience, with a strict selection of patients and following a care process with multidisciplinary participation, endourological procedures are feasible and safe in the outpatient setting. Periodic monitoring of the results is essential for the sake of a constant improvement of the process.

Keywords:
Lithiasis
Flexible ureteroscopy
Percutaneous nephrolithotomy
Ambulatory surgery
Outcomes
Complications
Resumen
Objetivo

La litiasis urinaria es una enfermedad prevalente y con elevado impacto socioeconómico, donde la cirugía endourológica ha demostrado excelentes resultados con mínimas complicaciones. Por su parte, la cirugía ambulatoria es un modelo asistencial eficiente, seguro y de calidad. Presentamos nuestra experiencia en el tratamiento endourológico ambulatorio de la litiasis renoureteral y una revisión de las principales series.

Material y métodos

Análisis prospectivo de 85 procedimientos flexibles o percutáneos para el tratamiento de la litiasis, llevados a cabo en nuestro centro entre enero de 2021 y abril de 2022. Se estableció como objetivo principal analizar la tasa de ingreso no planificado y como objetivos secundarios el éxito e incidencia de complicaciones. Los pacientes fueron seleccionados siguiendo los criterios del proceso asistencial.

Resultados

La edad media fue de 56 ± 14 años. El urocultivo fue positivo en el 13,9% de los pacientes, siendo portadores de doble J prequirúrgico el 38%. Mediana de superficie litiásica de 55 mm2, con 961 ± 323 Unidades Hounsfield. Se realizaron 73 procedimientos flexibles y 12 percutáneos. 8 pacientes requirieron ingreso no planificado inmediato y otros 2 durante el primer mes. El 94% se encontraban libre de litiasis al tercer mes. No se detectaron complicaciones intraoperatorias, aunque el 16,5% de los pacientes presentaron algún tipo de complicación postoperatoria.

Conclusión

En nuestra experiencia, con una estricta selección de los pacientes y siguiendo un proceso asistencial con participación multidisciplinar, los procedimientos endourológicos son factibles y seguros en el ámbito ambulatorio. La monitorización periódica de los resultados es fundamental en aras de una mejora constante del proceso.

Palabras clave:
Litiasis
Ureteroscopia flexible
Nefrolitotomía percutánea
Cirugía ambulatoria
Resultados
Complicaciones

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