Comparison of Outcomes between Two Methods to Extract Stone Fragments during Flexible Ureteroscopic Lithotripsy

OBJECTIVES: To retrospectively compare the operative and clinical outcomes of flexible ureteroscopic lithotripsy (fURSL) with stone extraction performed either by a surgeon (SE) who manipulates the retrieval basket or by having the surgical assistant (AE) manipulate the retrieval basket with the aim of clarifying which method provides a greater stone-free postoperative status. METHODS: The study group consisted of patients who underwent fURSL with SE or AE at our institution between April 2015 and December 2016. Demographic, clinical, stone, and operative variables were compared between the two groups. Multivariate logistic regression was used to identify risk factors associated with a stone-free and non-stone-free status postoperatively. RESULTS: Our analysis included 196 cases of renal stones treated using fURSL, with 109 who underwent AE and 87 who underwent SE. The rate of stone-free status was higher for the SE group (90.8%) than for the AE group (61.5%; P < 0.001). The method of extraction was identified as an independent predictor of stone-free status (P < 0.001, odds ratio (SE compared to AE), 9.133, 95% confidence interval, 3.736–22.322). CONCLUSION: The stone-free rate is improved by having the surgeon perform the stone extraction as part of the fURSL procedure.