The development of ureteric strictures after ureteroscopic treatment for ureteric calculi: A long-term study at two academic centres

Abstract

ObjectiveTo determine the incidence of symptomatic and ‘silent’ obstruction after ureteroscopic procedures.Patients and methodsIn all, 1980 patients underwent ureteroscopy for ureteric calculi in two large centres. The methods of disintegration, auxiliary procedures used and type of stenting were considered. Intraoperative complications, in addition to the size and site of the stone, were assessed in relation to postoperative obstruction. The mean (range) follow-up was 42 (12–68) months, with patients assessed after 3–6 months and yearly thereafter. The postoperative evaluation included an assessment of pain, renal ultrasonography, a plain abdominal film, intravenous urography, and a diuretic renal scan in some cases to confirm obstruction.ResultsThe success rate of stone removal was 98.5%. The failures were related to the size of the stone (>2 cm; P < 0.001). In eight patients there was a ureteric perforation, and six of these developed a ureteric stricture. A stricture also occurred in 12 patients (0.6%) during the follow-up; these included nine of 204 with stones of >2 cm (4.4%), compared to three (0.17%) of 1746 patients with stones of <2 cm (P < 0.001). Fourteen patients presented with pain (0.7%), and five had no obstruction, while in nine (0.46%) the pain was associated with obstruction. There was silent obstruction in three cases (0.15%). The negative and positive predictive values for pain were 99.8% and 64.3%, respectively.ConclusionsRadiographic surveillance for stricture formation and obstruction is mandatory in patients who are symptomatic after ureteroscopy, and for up to 18 months in patients with intraoperative complications or with a stone of >2 cm in the proximal ureter.

Risk Factors for Ureteral Damage in Ureteroscopic stone Treatment: Results of the German Prospective Multicentre Benchmarks of Ureterorenoscopic Stone Treatment-Results in Terms of Complications, Quality of Life, and Stone-Free Rates Project

“…Defining risk factors is also important in light of the fact that even ureteral lesions that do not perforate the ureter (PULS 1 and 2, Fig. 1) trigger later complications -especially strictures -that may cause the need for complex reconstructive surgery [12]. One of our study hypotheses was that preoperative ureteral PULS, post-ureteroscopic lesion scale; URS, ureteroscopy.…”

Complications of Endourologic Procedures: A Review on Iatrogenic Ureteral Perforation

“…The incidence has decreased in the clinical series over the last ten years, due to better designed equipments and surgical instruments, causing fewer traumas. Improvements such as a decrease in diameter and size, telescoped and non-traumatic ends and the development of hydrophilic ancillary equipment, specifically designed for ureters 22 . In current publications, rates vary from 0.4 to 6.25% [22,23] .…”

“…Improvements such as a decrease in diameter and size, telescoped and non-traumatic ends and the development of hydrophilic ancillary equipment, specifically designed for ureters 22 . In current publications, rates vary from 0.4 to 6.25% [22,23] . Regarding the main clinical series, two multicentric studies from the Clinical Research Office of the Endourological Society (CROES) report perforation percentages of 1% and 0.7-1.6%, respectively [5,11] .…”

“…El-Nahas et al [26] found that in addition to surgeon's inexperience, lithiasis size and location and whether the stone was impacted or not, are significant factors affecting perforation incidence.There is a higher perforation incidence in patients with calculi measuring over 15 mm [23,9,27]. Specifically, 62.5% of perforations occur in lithiasis measuring over 20 mm [22] . There are significant differences regarding the location of perforation in proximal and lumbar ureter versus distal ureter, being 1.6% and 0.7% respectively [11] .…”

“…It is considered a major complication due to its associated side effects, including pain, infection, obstructive nephropathy and even loss of renal unit function [7] . The incidence of strictures is usually lower than 1% [5,22,38] . In fact, the CROES reported a 0.3% stricture incidence [5] .…”