Retrograde Ureteroscopy for Urolithiasis in a North African Tertiary Center: A 4-Year Experience with Exceptionally Low Complication Rates

Retrograde ureteroscopy has become a first-line treatment for urinary lithiasis, particularly for stones in the upper urinary tract. We present a retrospective analysis of 156 consecutive ureteroscopy procedures performed between January 2020 and December 2023. The primary objective was to evaluate clinical outcomes, treatment efficacy, and safety profile in a North African tertiary center. The cohort consisted of 92 males and 64 females with a mean age of 52.1 years. Notable comorbidities included hypertension in 32 patients (20.5%) and diabetes mellitus in 22 patients (14.1%). Stone characteristics revealed diverse locations, predominantly calyceal (53.9%), with 19 staghorn calculi (12.2%) and 33 multiple calyceal locations (21.8%). Mean stone density was 890.74 ± 180 Hounsfield Units. Preoperative double-J stenting was performed in 96.2% of cases, and systematic antibiotic prophylaxis was administered to all patients. Complete stone fragmentation was achieved in 109 patients, representing a success rate of 69.9%. The postoperative complication rate was exceptionally low at 3.2%, with all five complications classified as Clavien-Dindo grade II acute pyelonephritis managed conservatively with antibiotics. No ureteral strictures, perforations, severe sepsis, or deaths occurred. Mean hospital stay was 1.15 days, with 89.7% of patients discharged within 24 hours. These results demonstrate that ureteroscopy is a safe and effective procedure for urinary lithiasis management in our setting, with outcomes comparable to international standards despite resource limitations in a developing healthcare context.