Repeat Surgery After Ureteroscopic Laser Lithotripsy With Attempted Complete Extraction of Fragments: Long-term Follow-up

Objective To explore repeat surgery as a primary outcome measure in long-term follow-up after ureteroscopic laser lithotripsy (URS) with attempted complete extraction of fragments. Methods Retrospective review of the medical records of consecutive patients undergoing URS performed by a single surgeon. Repeat surgery was defined as any return to the operating room for management of stone or complications. For our survival analysis, we used the Kaplan-Meier method. Results From April 2003 through May 2005 at our institution, URS was performed in 226 renal units in 216 patients. At a median follow-up of 4.1 years, 19 patients required repeat surgery. At 1 year, the cumulative repeat surgery rate (CRR) was 5.8% (95% confidence interval, 3.4%-9.8%), rising to 8.6% (5.6%-13.1%) at 5 years. CRR was strongly related to evidence of residual stone on postoperative computed tomography ( P 4 mm. The Cox proportional hazards ratio was 9.08 (2.11-38.00; P = .003) with fragments that were >2 mm; the ratio was 22.14 (5.15-95.14; P 4 mm. Conclusion Repeat surgery after URS is proportional to the size of residual fragments. Repeat surgery is a discrete objective metric that is consistent with, but does not require, rigorous postoperative radiologic assessment.