Ureteral avulsion as a complication of ureteroscopy

Alapont, J.M.; Broseta, Enrique; Oliver, F.; Pontones, J.L.; Boronat, F; Jiménez-Cruz, J.F.

doi:10.1590/s1677-55382003000100004

Cited by 31 publications

(34 citation statements)

References 14 publications

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“…Similar findings have been revealed in various other studies. (19)(20)(21) Present study has certain shortcomings. Ureteroscopy was not performed by a single urologist, which may have influenced the outcome.…”

Section: Discussionmentioning

confidence: 91%

A Prospective Study Comparing Stenting Versus Non-Stenting After Uncomplicated Ureteroscopy for Ureteric Stones

Reddy¹,

Prathvi²,

Kulshreshtha³

et al. 2016

jemds

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The placement of stents has been a standard practice since 1967. The advantage of routine stenting is that it minimizes postoperative ureteral obstruction and renal colic that may result from ureteral oedema caused by balloon dilatation or stone manipulation. There are various disadvantages resulting from it including flank pain, voiding symptoms, infections, stent related stone formation and encrustation. Various studies recommend them to be used only for procedures with complications such as ureteric injury or if a stone fragment remained at the end of the procedure. The aim of our study was to assess the need for routine ureteral stenting after uncomplicated ureteroscopic stone removal. MATERIALS AND METHODSThis study was conducted at Rajarajeshwari Medical College and Hospital, Bangalore, as a prospective randomized controlled trial in Department of Urology between January 2015 and May 2016. In this hospital-based prospective, comparative study, all patients were treated by ureteroscopic lithotripsy. Following the procedure, patients were randomized to the non-stented (n=44) who had no stent placed at the end of the operation and stented (n=52) group having Double DJ stent placement. The assessment criteria included operative time, success rate, postoperative analgesia, complications including (Flank pain, dysuria, haematuria, frequency/urgency), UTI, fever, rehospitalisation and hospital stay. RESULTSThe two groups were comparable with respect to baseline variables of age, gender, mean stone size, side of stone and number of patients turning for radiological follow-up at 3 months. The mean operative time was 38.12±10.76 minutes in the stented group and 32.22±6.72 minutes in the non-stented group. However, this difference was statistically insignificant. There was no significant difference in the two treatment groups with regard to use of intracorporeal lithotripsy. Ureteral dilatation was not required in any patient in both groups. A successful outcome was achieved in 100% of the cases in both groups. Patients with double J stents had statistically significantly more frequency/urgency, dysuria and need of analgesics compared to those without stents. There was no significant difference between the three groups regarding haematuria, fever, flank pain, urinary tract infection, rehospitalisation and mean hospital stay. CONCLUSIONRoutine ureteral stenting does not appear to be warranted in those patients who do not require ureteral dilation during ureteroscopic procedures. Patients without stents had significantly less pain, fewer urinary symptoms and decreased analgesic use postoperatively. Another advantage is cost effectiveness and avoidance of cystoscopy for stent removal.

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Section: Discussionmentioning

confidence: 91%

A Prospective Study Comparing Stenting Versus Non-Stenting After Uncomplicated Ureteroscopy for Ureteric Stones

Reddy¹,

Prathvi²,

Kulshreshtha³

et al. 2016

jemds

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“…1 One of the most frequently reported causes of complete ureter avulsion was stone manipulation with a basket. 2 However, the immediate cause of ureter avulsion in the above cases was narrowing of the ureteral lumen. Thus, surgical indications must be carefully chosen to avoid serious complications such as ureteral avulsion.…”

Section: Discussionmentioning

confidence: 92%

“…The optimal management of ureteral avulsion is determined according to factors relating to age and general physical condition of patients, degrees of tearing along the ureter, functions of the affected kidneys, and the lengths of the remaining ureters. 2 Various surgical approaches have been proposed for the management of such conditions, and in the absence of segmental defects of the ureter, ureteropelvic anastomosis, end-toend ureteral anastomosis, and ureteroneocystostomy are among the most commonly adapted techniques. However, the management of ureteral defects requires more complicated procedures such as ileal interposition, appendix interposition, transureteroureterostomy, Boari flap, psoas hitch, autotransplantation of the kidney, or even nephrectomy.…”

Section: Discussionmentioning

confidence: 99%

Management of complete ureteral avulsion in ureteroscopy

et al. 2014

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a b s t r a c tUreteral avulsion is an uncommon yet severe complication of ureteroscopy. Among 8336 patients who received ureteroscopic procedures in our hospital from December 2001 to December 2011, we encountered two cases of ureteral avulsion. The first of these experienced disruption at the ureteropelvic junction due to extraction of the tubular ureter from the urethra, which was corrected by immediate open surgery to reposition and anastomose the ureter. The second patient sustained a proximal ureteral disruption following retrieval of the ureteroscope, which was wedged in the narrow lumen of the proximal ureter, and led to simultaneous extraction of the distal ureter. Immediate surgical intervention was performed to maintain ureteral continuity. Mild hydronephrosis was observed in kidneys that were ipsilateral to the ureteral avulsion in both patients. However, no physical discomfort or loss of renal function was indicated after 12 months.

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“…Auto-transplantation is the most promising method for proximal avulsion. Ileal or appendix interposition will do if auto-transplantation is not possible (27).…”

Section: Bayar Et Al Ureteroscory In Impacted Ureteral Stonesmentioning

confidence: 99%

Ureteroscopy Outcomes, Complications and Management of Perforations in Impacted Ureter Stones

Bayar¹,

Tanrıverdi²,

Horasanlı³

et al. 2016

jus

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İmpakte üreter taşı olan hastalara yapılan üreteroskopinin sonuçlarını ve gelişen perforasyonların yönetimini değerlendirmeyi amaçladık. Gereç ve Yöntemİmpakte üreter taşı için opere edilen 81 hastanın verileri retrospektif olarak incelendi. Operasyon sırasında gelişen komplikasyonlar görsel olarak değerlendirildi, gereğinde retrograd üreterografi çekildi. Perforasyonun üreter çevresinin %50'sinden küçük olduğu yaralanmalara minör, büyük olmasına da majör perforasyon denildi. Perforasyonun evresine göre sadece double-j stent ile veya açık onarımla tedavi yapıldı. Bulgularİlk seansta tam taşsızlık oranı %69 olarak bulunurken, 3. ayın sonunda bu oran %79 idi. Komplikasyon 34 (%42) hastada gelişti. Minör perforasyon beş hastada gelişti. Bunların tamamına işlem sonunda double-j stent kondu. Bu beş hastanın dördünde (%80) kalıcı darlık gelişti. Major perforasyon gelişen üç hasta ise açık operasyona geçilerek fibrotik segment rezeke edilip taş alındıktan sonra uç uca anastomoz yapılarak tedavi edildi. Bu üç hastanın hiçbirinde darlık gelişmedi. Striktür oranı sadece double-j ile tedavi edilenlerde perforasyon oranı daha düşük olmasına karşın anlamlı olarak daha yüksekti (%80'e karşı %0 p=0,028). Taşın üst lokalizasyonda ve 10 mm'den büyük olması, kır-bırak stratejisinin kullanılmaması da komplikasyonları predikte eden faktörler olarak tespit edildi. Sonuçİmpakte üreter taşlarında, özellikle üst lokalizasyonda ve 10 mm'den büyük olanlarda, üreteroskopi düşük başarı ve yüksek komplikasyon oranına sahiptir. Perforasyon geliştiğinde ise konservatif tedavinin başarı şansı çok düşüktür. Bu nedenle perforasyon geliştiğinde açık operasyona geçilerek fibrotik segment rezeke edilmeli ve uç uca anastomoz yapılmalıdır. Anahtar Kelimelerİmpakte üreter taşı, üreteroskopi, üreter striktürü ABSTRACT ObjectiveTo evaluate ureteroscopy (URS) outcomes and management of perforations in impacted ureteral stones. Materials and MethodsWe retrospectively evaluated data from 81 patients who had undergone URS for impacted ureteral stones. Per-operative complications were evaluated visually and retrograde ureterography was performed when needed. Injuries of less than 50% around the ureter were classified as minor perforation and greater levels, as major perforation. Perforations were treated by double-j stent or a primary repair with consideration of the perforation grade. ResultsThe stone-free rate was 69% on the first URS attempt and 79% at the end of 3 months. Complications occurred in 34 (42%) patients. Minor perforation occurred in five patients and only double-j insertion was performed at the end of the procedure. Permanent ureteral stricture occurred in four of five patients. Three patients were treated by open ureterolithotomy, fibrotic segment resection and ureteroureterostomy due to major perforations. Transient or permanent ureteral stricture occurred in none of the three patients. The stricture rate was significantly higher in patients who were treated with double-j stent (80% vs. 0% p=0.028) although they had lower perforation rate....

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Ureteral avulsion as a complication of ureteroscopy

Cited by 31 publications

References 14 publications

A Prospective Study Comparing Stenting Versus Non-Stenting After Uncomplicated Ureteroscopy for Ureteric Stones

A Prospective Study Comparing Stenting Versus Non-Stenting After Uncomplicated Ureteroscopy for Ureteric Stones

Management of complete ureteral avulsion in ureteroscopy

Ureteroscopy Outcomes, Complications and Management of Perforations in Impacted Ureter Stones

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