Editorial Comment on de la Rosette et al.

This is the initial report of ureteroscopy from the Clinical Research Office of the Endourological Society (CROES). Analyzing the prospectively collected results of ureteroscopy in 11,885 patients, it represents one of the largest endourologic cohorts published. It is truly an international experience, with patient outcomes reported from more than 32 different countries. The purpose of this initial review of this cooperative's experience was to determine the indications, outcomes, and complications in patients undergoing ureteroscopy. The details and stratification of the results based on stone location and size are not yet available, but the overall stone-free rate was commendable (85.6%).

There were some notable findings. The most common complication was fever (in 1.8% of patients). Preoperative antibiotics were given in only 82.2% of patients. Despite many studies demonstrating the safety of ureteroscopy without postoperative stent placement, stents are still used in the vast majority of patients (84% in this study). There was also a readmission rate of 8.4%, although the reasons were not reported. Five patients died within 30 days after ureteroscopy (0.04%).

I am a bit discouraged that more of the ureteroscopy experience was not flexible. Most of these cases were distal ureteral stones managed with a rigid ureteroscope, and in nearly 25% of centers, flexible ureteroscopy was never reported. Is it realistic to expect other countries to increase their use of flexible, proximal ureteroscopy? Does this procedure need to be less expensive to be more widely adopted, or should this be a goal at all?

This study is quite an accomplishment, and the organizers of CROES should be congratulated. It demonstrates the clinical research possibilities of the CROES: The ability to organize a large number of international centers to quickly produce a broad clinical ureteroscopy series. This report represents the current state of ureteroscopy internationally, and the results are quite good. I am hopeful for future CROES studies that can help all of us continue to improve our ureteroscopy outcomes.