Withdraw of the Ureteroscope Causes Fragmented Ureter Stones to Disperse

Cangüven, Önder; Boz, Mustafa; Bulbul, Mustafa G.; Selimoglu, Ahmet; Albayrak, Selami

doi:10.1590/s1677-5538.ibju.2013.05.21

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“…We usually do not use a basket catheter to remove stones or stone fragments. Alternatively, grasping forceps are used to remove stone fragments larger than 3 mm, and sometimes, the ureteroscope is withdrawn to cause fragmented stones to disperse (8). A rigid ureteroscope is also a risk factor for ureteral avulsion as presented in the literature (9, 10) and in the three patients in our series.…”

Section: Discussionmentioning

confidence: 66%

The management of total avulsion of the ureter from both ends: Our experience and literature review

Sevinc¹,

Balaban²,

Özkaptan³

et al. 2016

Arch Ital Urol Androl

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Objective: To evaluate the treatment modalities of total ureteral avulsion and to clarify the risk factors of this serious complication. Methods: This study retrospectively analyzed the data of 3 patients with complete ureteral avulsion during ureteroscopy. Of the three patients, two had distal ureteral complete avulsion, and one total ureteral avulsion on both ends. Ureteroneocystostomy (UNC) was immediately performed after distal ureteral avulsion cases. Ileal ureter substition was performed on the same session after the total ureteral avulsion in both ends. Two of the patients were under chronic use of corticosteroid treatment due to diagnosis of idiopathic trombocytopenic purpura and myastenia gravis and all patients had unsuccesful shockwave litotripsy (SWL) treatment history with at least 1 month period before surgery. Results: The patient who had ileal ureter substitution was followed at 3-month intervals by ultrasonography and renal function tests and she was uneventful after a 2 year follow-up period. The patients treated with UNC were followed up at 3 month interval by ultrasonography and renal function tests. They had normal renal function 1 year after the operation Conclusion: Complete ureteral avulsion is a rare but severe complication. Treatment modality can vary and ileal ureter can be applied succesfully in the total ureter avulsion in both ends when bladder capacity is not enough for a Boari flap. Failed SWL and/or corticosteroid treatment history of patients seems to increase the risk of the ureteral avulsion.KEY WORDS: Avulsion; Lithotripsy; Ureterorenoscopy. quency of complications varies between 0.5% and 10% in the literature (1-3). Ureteral avulsion is the most serious complication and occurs in 0-0.5% patients (4). Treating ureteral avulsion is a challenge. Patient comorbidities, the condition of the kidney, severity of the ureteral damage, and experience of the surgeon can affect the choice of treatment. In this study, we aimed to discuss our experience and possible leading factors of this serious complication in the light of the current literature. MATERIALS AND METHODSWe retrospectively analyzed three ureteral avulsion cases and treatment modalities at two referral hospitals between January 2008 and October 2014. All patients underwent rigid ureteroscopic procedures for removing ureteral stones, and ureteral avulsion occurred during the retrograde examination of the ureter. Of the three patients (1 man, 2 women; age: 28-65 years, one right, two left), the avulsed ureter was repaired during the same session of the ureterorenoscopic surgery. The ureter stones were located in the distal ureter in two patients and in the proximal ureter in one patient. All patients had unsuccessful SWL treatment and at least a 2 week interval before further investigation and treatment were applied. Two patients who have been diagnosed with idiopathic thrombocytopenic purpura and myastenia gravis received chronic corticosteroid treatment. The patients were evaluated with abdominal X-ray, ultrasonography, int...

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Section: Discussionmentioning

confidence: 66%