Complications of Ureteroscopy: Analysis of Predictive Factors

Schuster, Timothy G.; Hollenbeck, Brent K.; Faerber, Gary J.; Wolf, J. Stuart

doi:10.1016/s0022-5347(05)65978-2

Cited by 203 publications

(131 citation statements)

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“…Harmon et al (19) observed a decrease in overall complications from 20% to 12% during a 10-year period which were attributed to smaller ureteroscopes and increased surgeon's experience. Schuster et al (20) suggested a significant reduction in ureteric perforation with a less operative time and postoperative complications with the surgeon's experience. Proximal migration of stones occurred in 2 patients (1.7%), which is less than what had been reported.…”

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confidence: 99%

Extracorporeal shockwave lithotripsy versus ureteroscopy for distal ureteric calculi: efficacy and patient satisfaction

2006

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Objective: We compared the efficacy of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) for the treatment of distal ureteral calculi with respect to patient satisfaction. Materials and Methods: This is a prospective study where a total of 212 patients with solitary, radiopaque distal ureteral calculi were treated with ESWL (n = 92) using Dornier lithotriptor S (MedTech Europe GmbH) or URS (n = 120). Patient and stone characteristics, treatment parameters, clinical outcomes, and patient satisfaction were assessed for each group. Results: The 2 groups were comparable in regard to patient age, sex, stone size, and side of treatment. The stone-free status for ESWL and URS at 3 months was 81.5% and 97.5%, respectively (p < 0.0001). In addition, 88% of patients who underwent ESWL versus 20% who underwent URS were discharged home the day of procedure. Minor complications occurred in 3.3% and 8.3% of the ESWL and URS groups, respectively (p = 0.127). No ureteral perforation or stricture occurred in the URS group. Postoperative flank pain and dysuria were more severe in the URS than ESWL group, although the differences were not statistically significant (p = 0.16). Patient satisfaction was high for both groups, including 94% for URS and 80% for ESWL (p = 0.002). Conclusions: URS is more effective than ESWL for the treatment of distal ureteral calculi. ESWL was more often performed on an outpatient basis, and showed a trend towards less flank pain and dysuria, fewer complications and quicker convalescence. Patient satisfaction was significantly higher for URS according to the questionnaire used in this study.

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Section: Commentsmentioning

confidence: 99%

Extracorporeal shockwave lithotripsy versus ureteroscopy for distal ureteric calculi: efficacy and patient satisfaction

2006

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“…[3][4][5]7,9,14,15 Complication rates during ureteroscopy correlate with prolonged operative duration, as well as surgeon experience.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5]7,9,14,15 Complication rates during ureteroscopy correlate with prolonged operative duration, as well as surgeon experience. 3 The treatment of impacted ureteral calculi are also associated with a greater rate of complications, as well as unsuccessful interventions. 16 In this case, use of a ureteral access sheath was thought to be associated with avulsion of the ureter from the UPJ.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] Iatrogenic ureteral injury varies from minor mucosal petechiae to erosion, perforation, and rarely complete ureteral avulsion. 6 Factors associated with higher complication rates during ureteroscopy are longer surgery times, treatment of renal calculi, surgeon inexperience, and previous irradiation.…”

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confidence: 99%

“…6 Factors associated with higher complication rates during ureteroscopy are longer surgery times, treatment of renal calculi, surgeon inexperience, and previous irradiation. 1,3,7 Ureteral stents are the cornerstone in the management of ureteral injury. If stent placement is not possible following ureteral injury, placement of a percutaneous nephrostomy tube is required for renal drainage until elective repair can be accomplished.…”

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confidence: 99%

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Simultaneous percutaneous nephrolithotomy and early endoscopic ureteric realignment for iatrogenic ureteropelvic junction avulsion during ureteroscopy

Tayeb

Mellon

Lingeman

2015

CUAJ

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E882Cite as: Can Urol Assoc J 2015;9(11-12):E882-5 http://dx.doi.org/10.5489/cuaj.2830 Published online December 14, 2015. AbstractWe present a case report of successful management of ureteropelvice junction avulsion during ureteroscopy successfully managed with simultaneous percutaneous nephrolithotomy and early endoscopic ureteral realignment. IntroductionThe incidence of ureteral injury and overall complications during ureteroscopy ranges from 0 to 28%. [1][2][3][4][5] Iatrogenic ureteral injury varies from minor mucosal petechiae to erosion, perforation, and rarely complete ureteral avulsion. 6 Factors associated with higher complication rates during ureteroscopy are longer surgery times, treatment of renal calculi, surgeon inexperience, and previous irradiation. 1,3,7 Ureteral stents are the cornerstone in the management of ureteral injury. If stent placement is not possible following ureteral injury, placement of a percutaneous nephrostomy tube is required for renal drainage until elective repair can be accomplished. 1,[8][9][10] Several authors have reported reasonable rates of success with ureteroscopic ureteral realignment for iatrogenic ureteral injury during gynecologic and general surgical procedures.9-13 However, to our knowledge, there has not been a previous report of successful endoscopic ureteral realignment following avulsion of the ureter at the level of the ureteropelvic junction. Case reportA 59-year-old female with a long history of nephrolithiasis had a 7-mm right renal pelvic calculus. Ureteroscopic treatment was performed at an outside institution. There was some difficulty with ureteral dilatation and UPJ avulsion of the ureter was suspected associated with insertion of the ureteral access sheath. A safety guide wire was not used during the procedure. Subsequently, a guide wire was not able to be passed beyond the injury into the renal collecting system and, therefore, a stent could not be placed. A 5F ureteral catheter was placed through the avulsed proximal ureter projecting into the retroperitoneum. The patient was transferred to Indiana University Health Methodist Hospital for subsequent management.The patient has a history of cirrhosis, splenomegaly, and thrombocytopenia with a platelet count of 52,000 and an INR of 1.5. Ureteroscopy was performed confirming complete avulsion of the ureter (Fig. 1). A stent could not be placed and a ureteral catheter was replaced into the retroperitoneum near the kidney. The following day a percutaneous nephrostomy was inserted by Interventional Radiology (Fig. 2). The patient was then returned to the operating room and placed in a prone split-leg position to allow for simultaneous antegrade and retrograde access to the ureter. The percutaneous access was dilated to 30F and an Amplatz sheath was positioned into the kidney (Fig. 3). Nephroscopy identified the stone in the renal pelvis which was removed. The UPJ was identified and noted to be very small in caliber. A flexible ureteroscope was passed antegradely through the UPJ confirming that the avu...

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Management of Complications Associated with Various Lithotripsy Techniques

Cottrell

Dickinson

2014

Urinary Stones

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Complications of Ureteroscopy: Analysis of Predictive Factors

Abstract: Longer duration of the ureteroscopic procedure is strongly associated with ureteral perforation. The likelihood of immediate postoperative complications is greater when renal calculi are treated and less when the surgeon is more experienced.

Cited by 203 publications

References 7 publications

Extracorporeal shockwave lithotripsy versus ureteroscopy for distal ureteric calculi: efficacy and patient satisfaction

Extracorporeal shockwave lithotripsy versus ureteroscopy for distal ureteric calculi: efficacy and patient satisfaction

Simultaneous percutaneous nephrolithotomy and early endoscopic ureteric realignment for iatrogenic ureteropelvic junction avulsion during ureteroscopy

Management of Complications Associated with Various Lithotripsy Techniques

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