Is Ambulatory Flexible Ureteroscopic Lithotripsy Safe and Feasible? Evidence from a Propensity Score–Matched Cohort

Objective 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. Methods 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), complication rates (Clavien-Dindo classification), hospitalization duration, and costs were analyzed. Results 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 (86.05% vs. 89.66%, P = 0.502). 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 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 ± 0.31 vs. 4.05 ± 1.08 days, P < 0.001), while cost differences became non-significant (27,532 ± 3,982 vs. 28,916 ± 4,205 RMB, P = 0.106). Conclusion Ambulatory fURS represents a safe and effective treatment option for selected patients with upper urinary tract stones. When performed under standardized perioperative protocols and appropriate patient selection, this model can substantially reduce hospitalization duration without compromising surgical outcomes or patient safety, thereby supporting more efficient utilization of healthcare resources.