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The aim of this study was to evaluate the impact of hours worked by a urologist before performing ureteroscopy on its safety and efficacy.Patients treated at a single institution from January 2010 to December 2013 were analyzed. The study assessed patient, stone and surgical parameters, stone-free rates and intraoperative complications performed in three work duration categories: less than 6 h, 6-12 h and more than 12 h of urologist's work. Statistical analyses included the chi-squared test, Kruskal-Wallis test, and univariate and multivariate logistic regression analyses.In total, 469 ureteroscopies were analyzed. Intraoperative complications differed non-significantly in the corresponding time categories: ureteral perforations (6 h 4.4%, 6-12 h 3.2%,12 h 7%, p = 0.46) and avulsions (all 0%). Rates for complete stone removal were 82% within the first 12 h vs 70.2% after 12 h (p = 0.03). Corresponding partial stone-free rates were 4.1% vs 3.5% (p = 0.83) and rates of unsuccessful ureteroscopy were 13.8% vs 26.3% (p = 0.01). In multivariate regression analysis, patients treated after 12 h of urologist's work had a 2.4 times higher risk of an unsuccessful ureteroscopy [odds ratio (OR) = 2.4, 95% confidence interval (CI) 1.2-4.7, p = 0.001] and lower chances of complete stone removal (OR = 0.46, 95% CI 0.24-0.89, p = 0.02). The odds of ureteral perforations were similar (p = 0.28).Work duration before ureteroscopy did not affect its safety. Stone-free rates decreased with increasing working time. Working time exceeding 12 h was identified as an independent risk factor for impaired stone-free rates.

Objectives: To evaluate the impact of retrograde pyelography (RPG) in patients treated with ureteroscopy (URS) for ureteral calculi. Methods: Retrospective analysis of patients treated with and without RPG prior to URS at a single institution from 2010 to 2013. Assessment of stone-free rates and intraoperative complications. Results: Out of 469 URS, 211 (45%) were done with and 258 (55%) without RPG. Complete stone removal was achieved in 86.8% without RPG compared to 73% with RPG (p = 0.0001). Partial stone removal rates were similar in both groups (p = 0.77). Stone removal was not achieved in 9.3 vs. 22.7% (p = 0.0001), with concordant findings in the distal (7.4 vs. 16.9%, p = 0.007) and the proximal ureter (14.5 vs. 38.6%, p = 0.002). Patients with RPG had a threefold higher chance of an unsuccessful URS (OR 3.05, 1.71-5.43, p < 0.0001) and were less likely of having a complete stone removal (OR 0.37, 0.22-0.61, p < 0.0001). Ureteral avulsions (0%) and ureteral perforation rates were similar (4.7 vs. 3.8%, p = 0.65). Conclusions: Patients treated with an RPG prior to URS had significantly inferior stone-free rates. RPG was identified as an independent risk factor for inferior results. RPG neither facilitates nor diminishes complication rates during URS.