Ureterorenoscopy: Avoiding and Managing the Complications

D’Addessi, Alessandro; Bassi, Pierfrancesco

doi:10.1159/000329286

Cited by 40 publications

(25 citation statements)

References 108 publications

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“…Today, it is increasingly used in the management of the common ureteral stones, and such frequent indication has made ureteroscopy become a worldwide technique, with the expected appearance of multiple types of complications (9-20%), some of them severe, including ureteral perforation or avulsion, bleeding, and urinary tract infection [2,3,4]. …”

Section: Discussionmentioning

confidence: 99%

Renal Subcapsular Hemorrhage Complicating Ureterolithotripsy: An Unknown Complication of a Known Day-to-Day Procedure

Meng

Chen

et al. 2013

Urol Int

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Objective: To report the incidence, risk factors, and treatments of renal subcapsular hemorrhage (RSH) complicating ureteroscopic lithotripsy (URSL). Patients and Methods: Data from 1,918 URSLs performed between January 2004 and March 2012 were retrospectively analyzed. Patients' data included age, sex, relevant medical history, stone side, size, and degree of hydronephrosis. Results: All 8 patients were identified as having an RSH after URSL. There were 2 males and 6 females with a mean age of 45.6 years (range 30-62 years). The patients' relevant medical histories (renal calculi extracorporeal shock wave lithotripsy, renal operation and hypertension) were statistically different between those who did and did not develop an RSH. Acute onset of flank pain is the most common symptom. Three patients with infective and large hemorrhage were managed by percutaneous nephrostomy in 1 and percutaneous subcapsular drainage in 2. Five patients with small and uninfected hemorrhage were managed conservatively. Conclusions: The rate of development of RSH complicating URSL is very low. RSH complicating URSL can occur in patients with underlying renal abnormalities. RSH is rarely associated with abrupt hemodynamic instability and usually not lethal. Treatment is selected based on the patient's hemodynamic state, infection, renal function, and the feasibility of treatment modality.

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Section: Discussionmentioning

confidence: 99%

Renal Subcapsular Hemorrhage Complicating Ureterolithotripsy: An Unknown Complication of a Known Day-to-Day Procedure

Meng

Chen

et al. 2013

Urol Int

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“…The success rate can be increased with the use of an access sheath and relocation of the LP stone to a more favorable location. RUR is now a well-established procedure to treat LP stones with a low incidence of complications [21]. Obese patients or those with noncorrected coagulopathy and those with hard stones that fail with SWL are ideally indicated for the ureteroscopic approach [4].…”

Section: Discussionmentioning

confidence: 99%

Lower Pole Midsize (1–2 cm) Calyceal Stones: Outcome Analysis of 56 Cases

2012

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Objectives: To compare efficacy of shockwave lithotripsy (SWL) with percutaneous nephrolithotomy (PNL) and retrograde ureterorenoscopy (RUR) in the management of midsize (1–2 cm) lower calyceal stones and the impact of lower pole (LP) anatomy on lithotripsy results. Patients and Methods: Between 2007 and 2011, 56 patients with lower calyceal stones 1–2 cm were indicated for intervention. 24 patients were treated with SWL, 19 with PNL, and 13 with RUR. Results: Mean age at surgery was 53, 45 and 47 years for SWL, PNL and RUR, respectively. Mean stone size was 15.6 ± 4.3, 17.3 ± 3.3 and 14.5 ± 3.2 mm, respectively. The stone-free rate was 62.5, 89.4 and 74.6%, respectively (p > 0.05). The mean time of procedures was 48.3 ± 16 min compared to 63 ± 32 and 76 ± 34 min in PNL and RUR, respectively (p > 0.05). In the SWL group there was a significant difference in LP anatomical measurements between the stone-free group and residual stone group. Conclusion: SWL is an effective treatment modality for patients with favorable LP calyceal anatomy. PNL and RUR with laser lithotripsy are effective therapeutic alternative options in midsize (1–2 cm) lower calyceal stones. This study may be limited by its retrospective nature and modest sample size, but it is enhanced by comparing three different treatment modalities.

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“…quency of complications varies between 0.5% and 10% in the literature (1)(2)(3). Ureteral avulsion is the most serious complication and occurs in 0-0.5% patients (4). Treating ureteral avulsion is a challenge.…”

Section: Original Papermentioning

confidence: 99%

The management of total avulsion of the ureter from both ends: Our experience and literature review

Sevinc¹,

Balaban²,

Özkaptan³

et al. 2016

Arch Ital Urol Androl

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Objective: To evaluate the treatment modalities of total ureteral avulsion and to clarify the risk factors of this serious complication. Methods: This study retrospectively analyzed the data of 3 patients with complete ureteral avulsion during ureteroscopy. Of the three patients, two had distal ureteral complete avulsion, and one total ureteral avulsion on both ends. Ureteroneocystostomy (UNC) was immediately performed after distal ureteral avulsion cases. Ileal ureter substition was performed on the same session after the total ureteral avulsion in both ends. Two of the patients were under chronic use of corticosteroid treatment due to diagnosis of idiopathic trombocytopenic purpura and myastenia gravis and all patients had unsuccesful shockwave litotripsy (SWL) treatment history with at least 1 month period before surgery. Results: The patient who had ileal ureter substitution was followed at 3-month intervals by ultrasonography and renal function tests and she was uneventful after a 2 year follow-up period. The patients treated with UNC were followed up at 3 month interval by ultrasonography and renal function tests. They had normal renal function 1 year after the operation Conclusion: Complete ureteral avulsion is a rare but severe complication. Treatment modality can vary and ileal ureter can be applied succesfully in the total ureter avulsion in both ends when bladder capacity is not enough for a Boari flap. Failed SWL and/or corticosteroid treatment history of patients seems to increase the risk of the ureteral avulsion.KEY WORDS: Avulsion; Lithotripsy; Ureterorenoscopy. quency of complications varies between 0.5% and 10% in the literature (1-3). Ureteral avulsion is the most serious complication and occurs in 0-0.5% patients (4). Treating ureteral avulsion is a challenge. Patient comorbidities, the condition of the kidney, severity of the ureteral damage, and experience of the surgeon can affect the choice of treatment. In this study, we aimed to discuss our experience and possible leading factors of this serious complication in the light of the current literature. MATERIALS AND METHODSWe retrospectively analyzed three ureteral avulsion cases and treatment modalities at two referral hospitals between January 2008 and October 2014. All patients underwent rigid ureteroscopic procedures for removing ureteral stones, and ureteral avulsion occurred during the retrograde examination of the ureter. Of the three patients (1 man, 2 women; age: 28-65 years, one right, two left), the avulsed ureter was repaired during the same session of the ureterorenoscopic surgery. The ureter stones were located in the distal ureter in two patients and in the proximal ureter in one patient. All patients had unsuccessful SWL treatment and at least a 2 week interval before further investigation and treatment were applied. Two patients who have been diagnosed with idiopathic thrombocytopenic purpura and myastenia gravis received chronic corticosteroid treatment. The patients were evaluated with abdominal X-ray, ultrasonography, int...

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Ureterorenoscopy: Avoiding and Managing the Complications

Cited by 40 publications

References 108 publications

Renal Subcapsular Hemorrhage Complicating Ureterolithotripsy: An Unknown Complication of a Known Day-to-Day Procedure

Renal Subcapsular Hemorrhage Complicating Ureterolithotripsy: An Unknown Complication of a Known Day-to-Day Procedure

Lower Pole Midsize (1–2 cm) Calyceal Stones: Outcome Analysis of 56 Cases

The management of total avulsion of the ureter from both ends: Our experience and literature review

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