Early surgical intervention versus medical expulsive therapy for renal colic

Abstract

derwent retrograde intra-renal surgery (RIRs) using ureteral access sheath from March 2010 to october 2010 in two different centrers. There were 92 men and 44 women with mean age was 51.6 years (ranged from 14 to 84). All UAS were 12 14 Fr. Group of patients (39.7 %) were pre-stented. At the end of procedure, ureteric injuries were evaluated clinically through endoscopic exploration. Therefore, we presented our classification of ureteric endoscopic injuries based on the anatomy of ureteric wall. When different types of injuries coexist, the higher grade was documented. Factors that affect clinical outcomes were evaluated statistically. RESULTS: From our data, 68 patients (50%) had no ureteric injury at the end of procedure. On the other hand, 68 patients had at least one iatrogenic injury of the ureteric wall. We reported, 47 patients with ureteral injury grade 1 (35%), 15 with grade 2 (11%) and 6 with ureteric perforation (4%). Patients characteristics such as age, gender, body mass index and history of previous ureteroscopy were not statistically significant. Nevertheless, the incidence of ureteric injuries was significantly lower in pre-stenting patients (p 0.0001). Moreover, operative time was correlated to the icidence of ureteraic injuries (p 0.031). CONCLUSIONS: Insertion of ureteral access sheath during RIRS procedure may induce severe ureteric injuries. Ureteral prestenting reduces significantly the incidence of this complication.