Flexible ureteroscopy with laser lithotripsy in Mauritania: first national experience, clinical outcomes, and economic impact in a resource-limited setting

Abstract

: Over the past decades, flexible ureteroscopy combined with laser lithotripsy (fURS-L) has become a reference technique for the management of upper urinary tract stones. However, its accessibility remains limited in low-resource settings due to economic and logistical constraints. In Mauritania, clinical experience and economic data regarding this technique remain poorly documented. We report here the first national experience, based on the first 20 cases of flexible ureteroscopy laser performed in our institution. This was a retrospective, descriptive, single-center study including the first 20 patients who underwent flexible ureteroscopy laser between May and December 2025. Epidemiological, clinical, radiological, operative, postoperative, and economic data were analyzed. The parameters assessed included stone characteristics, operative time, length of hospital stay, complications, stone-free rate, and overall procedural cost. The mean patient age was 42.8 years, with a male predominance (male-to-female ratio = 2.5). Stones were predominantly renal (75%), with a mean size of 18.6 mm. The mean operative time was 66 min, and the mean length of hospital stay was 24 ± 3 h. Two postoperative infectious complications classified as Clavien–Dindo grade II were observed (10%). The overall stone-free rate was 90%. The mean cost per patient for a single fURS-L session was estimated at 43,200 MRU, corresponding to approximately 920 €. Flexible ureteroscopy laser appears to be a feasible, effective, and safe technique for the management of urinary stones in Mauritania. Despite a high initial cost, it may represent a cost-effective therapeutic option in the medium and long term, by reducing hospital stay, complication rates, and the need for open surgery or medical evacuation.