Ureteroscopy: a population based study of clinical complications and possible risk factors for stone surgery

Abstract

IntroductionThe aim of this study was to describe the complications of ureteroscopy (URS) and to investigate whether performing URS outside normal working hours leads to increased risk for clinically significant complications.Material and methodsA cohort of 486 consecutive patients treated with URS, with a total of 567 sessions between 2009 and 2015 at Helsingborg/Ängelholm Hospital, Sweden, was analyzed. Outcome was complications within 14 days after URS treatment.ResultsWe found no increased risk of complications related to URS performed outside normal working hours. Stone-free rate (SFR) in the distal third of the ureter was 95.2% (315/331), in the middle ureter 92.8% (90/97), in the proximal ureter 84.0% (63/75) and 69.0% (40/58) in renal pelvis. The overall complication rate was 10.6% (n = 60). None of the potential risk factors for complications showed any significance when adjusted for age and gender. We found an inverse relationship between stenting and SFR (p = 0.002). The most common preoperatively cultured bacteria was Escherichia coli. With adequate antibiotics, there was no increased risk of complications. There was an increased risk of complications after URS related to age, but not with gender.ConclusionsURS in modern setting provides excellent results with adequate SFR and low morbidity. Time of day, the presence of urological specialized operating nurses did not affect the risk of complications and we found no other significant risk factors for complications. Escherichia coli was the most commonly found bacteria in preoperative cultures. The risk of complications increases with age. For patients >65 years old, this should be considered in preoperative counseling.

Can We Identify Patients in Danger of Complications in Retrograde Intrarenal Surgery?—A Retrospective Risk Factors Analysis

“…On the other hand, Berardinelli et al in 377 RIRS observed 15.1% of adverse events, including 8.4% (n = 30) post-operative, which revealed even lower prevalence: grade I in 6.9% (n = 26), grade II in 0.5% (n = 2), grade III in 0.5% (n = 2) [41]. Similarly, a Swedish study of 486 mixed semirigid and flexible URS groups by Wagenius et al described: grade I in 12.0% (n = 68), grade II in 6.5% (n = 7), grade III in 1.9% (n = 11) and grade IV in 0.2% (n = 1), which are comparable to the incidence of adverse events in the sample being discussed [42].…”