Factors affecting operative time during ureteroscopy and stone treatment and its effect on outcomes: retrospective results over 6.5 years

Abstract

Background: We aimed to evaluate operative time with the outcomes of ureteroscopy (URS) and investigate the relationship between these factors, and assess if longer operative times were associated with a higher risk of complications. Methods: We retrospectively audited consecutive cases of URS done between March 2012 and June 2018. Data were collected for operative times, patient demographics, stone parameters, stent insertions, use of ureteric access sheath, length of stay, stone-free rate (SFR) and complications. Statistical analysis was performed using IBM SPSS version 24. Results: Over 6.5 years, 736 patients with a male:female ratio of 1.8:1 and a mean age of 54.7 years (range: 2–91 years), underwent 860 URS and stone treatment procedures. The mean operative time was 43.5 min (range: 8–160 min), with a stone size of 12.3 mm (range: 3–100 mm) and access sheath was used in 35.8%. The initial and final SFR was 86% and 92.5%, respectively, and 85.6% ( n = 736) patients were discharged the same day of procedure. Treatment of multiple renal stones, ureteric and renal stones, large stones, use of access sheath and post-operative stent were all associated with longer operative times ( p <0.001). Patients who were stone free and those having day-case procedures had shorter operative times ( p <0.001). There were 27 (3.2%) Clavien I/II complications and 8 (0.9%) Clavien ⩾III complications. Clavien score ⩾III ( p = 0.028) and infectious complications ( p <0.001) had significantly longer operative times. Conclusion: Patients with shorter operative times have a higher chance of being discharged home the same day without a post-operative stent. Higher operative times are associated with high-grade, especially infection-related, complications.