LAUSR

INTRODUCTION We sought to compare the safety, efficacy, efficiency and surgeon experience during upper urinary tract stone management with single-lumen versus dual-lumen flexible ureteroscopes. MATERIALS AND METHODS Seventy-nine patients with proximal ureteral or renal stone burden < 2 cm were randomized to a single-lumen or dual-lumen flexible ureteroscopy. We recorded times for ureteroscopy, laser lithotripsy, stone basketing, as well as intraoperative and postoperative complications. The rate of stone clearance and stone free status were calculated using computed tomography imaging. Surgeons completed a survey after each procedure rating various metrics regarding ureteroscope performance. RESULTS Thirty-five patients from the single-lumen group and forty-four patients from the dual-lumen group had comparable median ureteroscopy time (37 vs 35 minutes, p=0.984) and basketing time (12 vs 19 min; p=0.584). Median lithotripsy time was decreased in the dual-lumen group (single: 6 vs dual: 2 min, p=0.017). The stone clearance rate was superior in the dual-lumen group (single: 3.7 vs dual: 7.1 mm3/min, p=0.025). The absolute stone-free rate was superior for the dual-lumen group (single: 26% vs dual: 48%, p=0.045). No differences in intraoperative (single: 0% vs dual: 2%; p=0.375) and postoperative complications (single: 7% vs dual: 11%, p=0.474) were observed. Surgeons' ratings of the dual-lumen ureteroscope was superior for visibility, comfort, ease of use, and overall performance. CONCLUSIONS The use of the dual-lumen ureteroscope in patients with renal and proximal ureteral stones < 2 cm provided shorter lithotripsy time, higher stone clearance rates, improved stone free rate and superior surgeon ratings when compared to single-lumen flexible ureteroscopes.