A pre-surgical brief was done on the day as per the World Health Organisation (WHO) checklist with the theatre and recovery team where a clear plan was made regarding antibiotic prophylaxis, venous thromboembolism (VTE) prophylaxis and any anticipated surgical or anaesthetic issues.
A protocol-based procedure was done for all patients under general anaesthetic. After initial cystoscopy and safety wire placement, a rigid URS was done using 4.5 or 6F Wolf or Storz semi-rigid ureteroscope over a working wire. For renal stones, based on surgeon discretion, a ureteral access sheath (UAS) was used (9.5F/11.5F or 12F/14F Cook Flexor sheath). A flexible ureteroscopy (Storz FlexX2) and laser (Lumenis, Ltd. Yokneam, Hakidma, Israel) stone treatment was then done using a Moses P60W laser (Group A) or Holmium 20 W laser (Group B). The laser setting used was 0.4–0.8 J, 20–35 Hz with Moses setting for group A and 0.4–0.8 J, 12–18 Hz for group B. Fragments were retrieved using Cook Ngage stone extractor (Cook Medical, Bloomington, IN, USA), with a 6F ureteral stent placed post-operatively when indicated.
A protocol-based procedure was done for all patients under general anaesthetic. After initial cystoscopy and safety wire placement, a rigid URS was done using 4.5 or 6F Wolf or Storz semi-rigid ureteroscope over a working wire. For renal stones, based on surgeon discretion, a ureteral access sheath (UAS) was used (9.5F/11.5F or 12F/14F Cook Flexor sheath). A flexible ureteroscopy (Storz FlexX2) and laser (Lumenis, Ltd. Yokneam, Hakidma, Israel) stone treatment was then done using a Moses P60W laser (Group A) or Holmium 20 W laser (Group B). The laser setting used was 0.4–0.8 J, 20–35 Hz with Moses setting for group A and 0.4–0.8 J, 12–18 Hz for group B. Fragments were retrieved using Cook Ngage stone extractor (Cook Medical, Bloomington, IN, USA), with a 6F ureteral stent placed post-operatively when indicated.