The impact of intraoperative findings during endoscopic ureteral stone treatment on stone recurrence at the fifth postoperative year

Urinary stone disease is a significant burden in urological practice because of its high prevalence and recurrence rates. Despite advances in endoscopic treatment, recurrence remains a major concern and is influenced by multiple factors such as metabolic disorders, anatomical abnormalities, and surgical outcomes. The holmium: yttrium-aluminum-garnet (Ho: YAG) laser is the gold standard for lithotripsy; however, the impact of intraoperative endoscopic findings on recurrence is not well established. This study aimed to evaluate the role of intraoperative observation in predicting stone recurrence after ureteroscopic lithotripsy. A total of 425 consecutive patients who underwent endoscopic ureteral stone treatment for ureteral stones between 2016 and 2017 at our institution were retrospectively reviewed. After application of the predefined inclusion and exclusion criteria, 114 patients were included in the final analysis. The patients were divided into two groups based on stone recurrence. Variables such as stone location, size, hydronephrosis, endoscopic findings (ureteral strictures, edema), and lithotripsy method were analyzed using the Mann–Whitney U test, chi-square test, Spearman correlation analysis, and multivariable binary logistic regression. The recurrence rate at five years was 35.08%. Multivariable logistic regression identified stone side as the only independent predictor of stone recurrence. However, no significant associations were found between stone recurrence and intraoperative endoscopic findings, including ureteral strictures and edema ( p > 0.05). The number of ureteroscopic accesses did not correlate with recurrence ( P = 0.218). Although previous studies have suggested that anatomical factors influence recurrence, our findings indicate that intraoperative endoscopic observations have limited impact. Because metabolic evaluation was not performed, no conclusions regarding the independent effects of metabolic factors on recurrence can be drawn. Prospective studies with larger cohorts are warranted.