Walk-in ureteroscopy and laser management service for urolithiasis in patients with renal colic: Lessons focusing on gains and challenges.

Introduction: We conceptualized a modified care pathway for renal colic management with the intention of expediting their treatment. This proof-of-concept study aimed at assessment of walk-in ureteroscopy outcomes in comparison to conservative treatment of urolithiasis with renal colic. Patients and Methods: Forty-two patients (32 in walk-in ureteroscopy group and 10 in the conservative group) with a mean age of 37 ± 10.2 years were confirmed to have ureteric/renal stones as the cause of renal colic using non-contrast computed tomography (CT) scan. Walk-in ureteroscopy and laser fragmentation procedures were offered to all. Those opting for the procedure underwent ureteroscopy and laser fragmentation. They were discharged immediately after the procedures and followed up in the clinic, including removal of stents. Patients with sepsis were excluded. Stone, free rate, and re-admission, including complications, were assessed and analyzed. Results: The mean time from CT detection to ureteroscopic laser fragmentation was 6 ± 3.4 h. All patients resumed work in 2-3 weeks and reported no further admission to hospital for stone-related events. 30 patients were stone free at a follow-up imaging at 6 weeks. One patient had a small residual stone fragment (<2 mm) located in the inferior calyx and required no further intervention. In contrast, 4 patients in the control group required at least two admissions each in emergency departments and continued to be off work for more than 3 weeks. Overall, 8 patients in the control group eventually required interventions in other hospitals, and two continued to have stones and managed pain conservatively with analgesics. Conclusions: In a modified pathway for renal colic management, walk-in ureteroscopy is feasible and safe. The procedure is associated with a very high stone-free rate and with early return to work and reduced re-admissions in comparison to the conservative management option. The study and its conclusions are limited by sample size and generalizability, as the procedures were carried out by experienced staff. Lack of randomization raises the possibility of selection bias as patients self-selected their treatment groups. Finally, the brief follow-up duration might not adequately reflect long-term results like recurrence or late complications.