Long segment right ureteric stricture following ureterorenoscopy for upper ureteric stone: A disastrous complication of endourology

Abstract

Background: Nephrolithiasis is a common ailment in developing countries such as India. Ureteroscopic management has superseded shockwave lithotripsy as the common treatment for upper urinary tract stones. The process of miniaturizing the instrument along with improved quality of video processor has amplified its potential application, maintaining the procedure safe and effective. However, with its extensive use, complications have risen in parallel, and one should be aware of its adverse effects. Ureteric stricture though rare is a serious problem and risks the loss of renal function. Case presentation: A 37-year-old male presented with right flank pain. On evaluation, he was diagnosed with right upper ureteric stone and left renal stone. The patient suffered ureteric perforation while the right ureterorenoscopy was being performed, and an open repair was done. On postoperative follow-up, he developed long segment ureteric stricture. Boari flap ureteroneocystostomy was done. Conclusion: Iatrogenic ureteric injury following ureterorenoscopy is common, minor and managed conservatively. Important tips to prevent major injury are: placement of the safety guide wire across the length of the ureter, small-calibre scopes during access if a tight gripping sensation is present and the use of lubricant along the length of the ureteroscope.

Comparing Ureteral Catheterization's Impact on Flank Pain Post Ureteroscopic Stone Management

“…Despite ureteroscopy's effectiveness, the procedure is not without risks. Major complications such as ureteral perforations and avulsions, though rare (occurring in approximately 1% of cases), can have significant consequences (10,11,12). Advances in surgical techniques and equipment have significantly reduced these risks.…”