Presented by: Alejandro García Sánchez MD
Hospital Virgen de Valme

Introduction

Since we introduced lithotripsy in our unit in 1986 (first public health service lithotripsy in Spain) treatment paradigm of lithiasis has changed, decreasing  number of cases treated with lithotripsy with an increase of cases solved endoscopically.

We present our experience in the surgical treatment of lithiasis in the Lithotripsy room of our center.

Our main objective is to evaluate the results after the procedures, complications rate, needing of second surgical time and the hospital stay.

Materials

We retrospectively analyzed  181 procedures performed between March 2016 and November 2022, including retrograde intrarenal surgery (RIRS) and ureteroscopy (URS).

Variables analyzed were age, history of lithiasis, type of surgery, laterality and lithiasis location, hardness and previous urinary diversion, lithiasis-free rate, complications, needing of a second surgical time and hospital stay.

Results

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Mean age was 53 years. 65% had a history of lithiasis: 21 (11.6%) previous endoscopic lithiasis surgery. 66.8% were classified as ASA II, followed by ASA III. No ASA IV were included.

181 interventions were performed. 134 URS (74%), 44 RIRS (24.3%) and 3 combined surgeries: Lithiasis in distal ureter (51.4%), proximal ureteral stones (12.7%).  In 2018, 21% were RIRS and 79% URS. In 2022, RIRS and URS were 43% and 55.4%, respectively.That means increasing complexity of cases treated. Bilateral lithiasis accounted for 3%. Mean lithiasis size and hardness varied between successive years. 48 patients required preoperative ureteral catheterization. 95.6 % of the procedures were completed in their entirety in one time, while in 8 cases surgery was not completed due to  ureteral or meatal strictures. 97% of the patients underwent some complementary test to evaluate the lithiasis-free rate. Computed tomography was the most frequently performed.

155 patients (85.6%) were free of lithiasis (no lithiasis in radiography or lithiasis remnant < 3 mm in tomography) after the first procedure. 17 patients required a second procedure. We achieved a total lithiasis-free rate of 95%.

Complications appeared in 12 cases (6.6%). 5 grade IIIb of Clavien Dindo. There was no mortality associated.

181 patients meant performing 17% of lithiasis procedures in 2022 in major ambulatory surgery environment and 12.5% in 2018.

Conclusion

Using lithotripsy room in the surgical treatment of urinary lithiasis is safe, effective, and efficient. Our experience has allowed us to increase the number of combined surgeries performed a year, increasing complexity with an adequate lithiasis-free rate and a low percentage of complications.

Funding

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Lead Authors

Carmen Arai Valladares Ferreiro, MD
Hospital Virgen e Valme

Co-Authors

Pedro Blasco Hernández, MD
Hospital Virgen de Valme