Is ambulatory flexible ureteroscopic lithotripsy safe and feasible? evidence from a propensity score–matched cohort

To evaluate the safety, efficacy, and health economic value of flexible ureteroscopic lithotripsy (fURS) for upper urinary tract stones in ambulatory surgery compared to traditional inpatient management. A retrospective cohort study analyzed 174 fURS cases performed by a single surgeon between January and December 2024. Patients were divided into ambulatory and inpatient groups. Propensity score matching (PSM, 1:1 ratio) was applied to balance baseline differences. Demographic data, perioperative parameters, and outcomes including stone-free rate (SFR, assessment via abdominal X-ray within 24 h postoperatively, with residual fragments > 2 mm considered significant), complication rates (Clavien-Dindo classification), hospitalization duration, and costs were analyzed. A total of 174 patients with upper urinary tract stones were included. Pre-matching analysis revealed that the inpatient group had significantly older age (58.55 ± 12.52 vs. 50.14 ± 12.79 years, P < 0.001), larger cumulative stone diameter (1.67 ± 0.74 vs. 1.34 ± 0.57 cm, P = 0.001), and longer operative time (53.09 ± 26.64 vs. 41.30 ± 21.45 min, P = 0.002). No significant differences were observed in postoperative complications (2.33% vs. 1.14%, P = 0.491) or SFR (80.23% vs. 82.95%, P = 0.789). The ambulatory group demonstrated a 74.6% reduction in hospitalization duration (1.09 ± 0.29 vs. 4.29 ± 1.14 days, P < 0.001) and lower unadjusted total costs (27,075.41 ± 4,112.93 vs. 29,240.94 ± 3,856.12 RMB, P < 0.001). Post-PSM analysis confirmed comparable baseline characteristics, with the ambulatory group maintaining shorter hospitalization (1.12 ± 0.33 vs. 4.18 ± 1.09 days, P < 0.001), with no statistically significant difference in total costs between the two groups (27,378.33 ± 3768.93 vs. 28,639.67 ± 4,033.38 RMB, P = 0.106). Ambulatory fURS represents a safe and effective treatment option for selected patients with upper urinary tract stones. This model substantially reduces hospitalization duration without compromising surgical outcomes or patient safety in carefully selected patients treated by experienced surgeons.