Complications Of Ureteroscopy Research Articles

Understanding ureteroscopy complications according to modified Clavien classification system.

To determine the complications of ureteric stone treatment with semi-rigid uretero-renoscopy in accordance with the modified Clavien classification system. The descriptive, prospective study was conducted at the Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, from June 30, 2020, to December 29, 2021, and comprised patients of either gender aged 18-70 years having ureteric stones. All patients were subjected to ureterorenoscopy using a semi-rigid ureteroscope under general anaesthesia. The patients were followed up for 2 months. All complications were noted and graded in line with the Modified Clavien Complication System. Ultrasound and X-ray were used to determine the stone-free rate. Data was analysed using SPSS 23. Of the 414 patients, 304(73.4%) were males and 110(26.5%) were females. The overall mean age was 40.22±13.10 years. There were 106(25.6%) proximal, 134(32.3%) middle, and 174(42%) distal ureteric stones. Stent placement was done in 56(13.5%) cases. There were 260(62.8%) patients with no complication, 90(21.7%) with grade I complications, 34(8.2%) with grade II complications, 10(2.4%) with grade IIIa, 8(1.9%) with grade IIIb, and 12 (2.9%) with grade IVa complications. Uretero-renoscopy was found to be a safe procedure, as it had minimal associated complications with optimal stone clearance and great dexterity. The Modified Clavien classification system was found to be an easy way to classify surgical complications of uretero-renoscopy.

Risk factors for Infectious Complications of Ureteroscopy after Obstructive Acute Pyelonephritis.

To identify risk factors for infectious complication of ureteroscopy after obstructive acute pyelonephritis (OAPN). This single-center, retrospective cohort study (#20200002, retrospectively registered in February 1st, 2020) included patients who underwent emergency drainage for OAPN and subsequently underwent ureteroscopic stone removal between January 2006 and December 2020. Multivariable analysis was conducted using demographic and stone-related factors to determine those that could predict postoperative febrile urinary tract infection (UTI). Overall, 432 patients underwent ureteroscopy after OAPN. The stone-free rate was 84.3%, whereas the overall and major complication rates were 17.6% and 3.2%, respectively. A total of 70 (16.2%) patient developed febrile UTI, among whom 34 (7.9%) and 11 (2.5%) developed sepsis and severe sepsis, respectively. Multivariable analysis identified diabetes mellitus [odds ratio (OR) 1.98, 95% confidence interval (CI) 1.05-3.74], duration from drainage to surgery >1 month (OR 2.28, 95% CI 1.20-4.74), and simultaneous retrograde intrarenal surgery (OR 2.96, 95% CI 1.35-6.48) as significant risk factors for UTI. After dividing patients into low- (0), intermediate- (1), and high- (2-3) risk groups according to the number of factors they had, the risk of postoperative UTI was 6.3%, 14.5%, and 27.7%, respectively (p for trend <0.001). Patients who underwent ureteroscopy after OAPN were at risk for postoperative UTI, despite its efficacy. Simultaneous retrograde intrarenal surgery should be carefully planned, especially for patients with diabetes mellitus or extended surgery wait times.

Систематизированный подход в оценке уретероскопических осложнений.

Introduction. Currently, ureteroscopy has become the method of choice for the treatment of patients with ureter stone location in lower third and middle third. Regardless of the fact that ureteroscopy is an endoscopic, minimally invasive intervention, it is associated with intraoperative complications. Purpose. The main objective of this literature review is to objectify the existing scales of ureter injury, demonstrate evolutionary changes from simple to more detailed, evaluate their advantages and disadvantages, and select the optimal and reproducible tool for assessing postureteroscopic complications. Materials and methods. In this literature review, we used research materials on existing scales of ureter injury published in the databases PubMed, the scientific electronic library of Russia (eLibrary), Scopus, EMBASE, websites of professional associations. Such keywords were used for searching: «postureteroscopic complications», «intraoperative complications of ureteroscopy», «ureteral injuries». This review focuses on the currently existing scales that assess ureteral injury, which can be universal and used in everyday practice. After a detailed check of the reliability of sources, the impact factors of journals and the sequence of presentation of the material, 28 sources were selected directly for citation. Results. According to literature review, historical and present-day knowledge of using postureteroscopic lesion scales in various surgical centers are presented here. Most of scales are focus on disruption of anatomical continuity of the ureter or on complications that develop during the implementation of surgical treatment, which are not specific for this procedure. However, the most detailed description of postureteroscopic complications makes it possible to distinguish between «complicated» and «uncomplicated» ureteroscopy. Conclusion. Thus, PULS scoring system is a standardized and easily reproducible tool in the evaluation of postureteroscopic complications. The emergence of new scales only emphasizes the importance and need for additional prospective and multicenter studies.

POSC410 Healthcare Utilization, Mortality, and Cost of Sepsis Post-Ureteroscopy Among a Medicare Population

Among stone disease patients, a potential serious complication of ureteroscopy (URS) is sepsis. Healthcare utilization and outcomes including death have not been previously reported. The objective of the current study was to evaluate healthcare utilization, in-hospital mortality, and costs of sepsis post-URS among a Medicare population.

Ureteral Balloon Complications in Ureteroscopy

Ureteral Balloon Complications in Ureteroscopy

Does previous unsuccessful shockwave lithotripsy influence the outcomes of ureteroscopy?-a systematic review and meta-analysis.

BackgroundTo determine whether previous unsuccessful shockwave lithotripsy (SWL) influence the outcomes of ureteroscopy (URS).MethodsAn exhaustive search of PubMed, EMBASE, Web of Science and Cochrane Library were conducted to find eligible studies before October 2020. Result variables consisting stone-free rate (SFR), operation time and postoperative modified Clavien grade I-IV complications were pooled utilizing RevMan 5.3.ResultsSeven studies with 2413 individuals were included. Pooled results revealed that the salvage URS after failed SWL was similar to URS performed primarily regarding SFR [odds ratio (OR) =0.84, P=0.15] and operation time [weighted mean difference (WMD) =6.79, P=0.19]. Additionally, no statistically significant differences concerning fever (OR: 1.36; P=0.32), hematuria (OR: 0.81; P=0.75), urinary tract infection (OR: 1.57; P=0.28), renal colic (OR: 1.94; P=0.50), ureteral perforation (OR: 1.44; P=0.46), ureteral avulsion (OR: 1.21; P=0.83), stone migration (OR: 0.92; P=0.86) and sepsis (OR: 0.46; P=0.38) were observed between salvage URS and primary URS group.DiscussionThe success rates and complications of URS were not impacted by previous unsuccessful SWL. The salvage URS is equally effective and safe to primary URS.

Complications of ureteroscopy: a complete overview.

The aim of this paper was to give a complete overview of all published complications associated with ureteroscopy and their according management and prevention in current urological practice. This review was registered in PROSPERO with registration number CRD42018116273. A bibliographic search of the Medline, Scopus, Embase and Web of Science databases was performed by two authors (V.D.C. and E.X.K.). According to the Population, Intervention, Comparator, Outcome (PICO) study design approach and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standards, a consensus between these authors was found relating to the thematic structure of this review. Ureteral stent discomfort, ureteral wall injury and stone migration are the most frequently reported complications. The worst complications include urosepsis, multi-organ failure and death. Incidence rates on these and other complications variedextensively between the reviewed reports. Ureteroscopy seems to be associated with more complications than currently reported.The present overview may help urologists to prevent, recognize and solve complications of ureteroscopy. It may also stimulate colleagues to perform prospective studies using standardized systems for classifying complications. These are warranted to compare results among different studies, to conduct meta-analyses, to inform health care workers and to counsel patients correctly about possible risks of ureteroscopy.

Cost-Effectiveness Analysis of the Management of Distal Ureteral Stones in Children

To determine the most cost-effective approach to the management of distal ureteral stones in children given the potential for recurrent renal colic during a trial of passage versus potential stent discomfort and complications of ureteroscopy. We developed a decision tree to project costs and clinical outcomes associated with observation, medical explusive therapy (MET), and ureteroscopy for the management of an index patient with a 4-mm-distal ureteral stone. We determined which strategy would be least costly and offer the most pain-free days within 30days of diagnosis. We performed a one-way sensitivity analysis on the probability of successful stone passage with MET. We obtained probabilities from the literature and costs from the 2016 Pediatric Health Information System Database. Ureteroscopy was the costliest strategy but maximized the number of pain-free days within 30days of diagnosis ($5282/29 pain-free days). MET was less costly than ureteroscopy but also less effective ($615/21.8 pain-free days). Observation cost more than MET and was also less effective ($2139/15.5 pain-free days). The one-way sensitivity analysis on the probability of successful stone passage with MET demonstrated that ureteroscopy always has the highest net monetary benefits value and is therefore the recommended strategy given a fixed willingness-to-pay. Using a rigorous decision-science approach, we found that ureteroscopy is the recommended strategy in children with small distal ureteral stones. Although it costs more than MET, it resulted in more pain-free days in the first 30days following diagnosis given the faster resolution of the stone episode.

Ureteral stricture after ureteroscopy for stones: A prospective study for the incidence and risk factors.

Context:A ureteral stricture is a serious complication of ureteroscopy (URS) that was reported in the literature in highly variable rates from 0.2% to 24%.Aims:Our aims are to estimate the incidence and to detect the risk factors of ureteral stricture after URS.Settings and Design:This is a prospective, case-series study.Materials and Methods:During the period from May 2015 to August 2016, 251 adult patients underwent 263 URS for the treatment of 304 ureteral stones. Postoperative regular follow-up was done for 12 months by ultrasound. Computed tomography urography and diuretic renogram were performed for the cases developed hydronephrosis to confirm and detect the level of the stricture.Statistical Analysis:IBM SPSS Statistics for Windows, Version 19.0, Armonk, NY: IBM Corp. used for data analysis. Chi-square and Fisher's exact tests were used to compare between qualitative variables. Mann–Whitney test was used to compare between two quantitative variables in case of nonparametric data. Multiple logistic regression analysis was done to measure the risk factors. P value was considered statistically significant when <0.05.Results:The mean age was 43.5 years (standard deviation [SD]: ±13.6), and the mean body mass index was 28.39 (±3.96). The mean total stone burden was 12.8 mm (SD: ±5.9). Bilateral URS was performed in 12 cases. The mean operative time was 54.8 min (SD: ±22.68). Initial and final stone-free rates were 83.3% and 100%, respectively. The overall complications rate was 28.1%. Stricture occurred in four cases (1.5%).Conclusions:In our experience, the incidence of post-URS ureteral stricture is low. The impacted stone is the most common cause of URS complications and hence stricture formation.

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

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.

Early complications of diagnostic and therapeutic ureteroscopy

Objective: The aim of this study is to report early complications of diagnostic and therapeutic ureteroscopy and to grade each complication according to modified Clavien classification system (MCCS). Materials and Methods: Through a prospective study conducted from March to September 2017, all patients who underwent diagnostic and therapeutic semirigid ureteroscopy were evaluated. The procedure was performed by different surgeons. The recording data included patient demographics, ureteroscopy site (left, right, or bilateral), aim of ureteroscopy (diagnostic or therapeutic), operative time, additional intervention, stone-free rate, double J stent placement, and complications which were graded according to the modefied clavien classification system with their management. Results: One hundred and fifty patients were included in the study. The average age was 39.9 years and male-to-female ratio 2.3/1. The number of patients who underwent right, left, and bilateral ureteroscopy was 74 (49.3%), 64 (42.3%), and 12 (8%), respectively, so the overall number of ureteroscopy procedures was 162. Diagnostic ureteroscopy was done in 20 (13.3%) patients and therapeutic ureteroscopy in 130 (87.7%). Complications occurred in 37.3% of patients. According to MCCS, Grade I, II, IIIa, IIIb, IVa, IVb, and V complications were detected in 40 (26.6%), 6 (4%), 10 (6.7%), 14 (9.3), 0 (0.0%), 2 (1.3%), and 0 (0.0%) of cases, respectively. Conclusion: Ureteroscopy becomes the prevailing procedure for different ureteral pathologies mainly stones with a good safety and efficacy. It is important to adopt a precise classification system for reporting the complications of ureteroscopy. Most of the complications are of low grade and they are amenable to conservative management. The complications of ureteroscopy will continue to decline as the ureteroscopic technology evolved.

Extended boari-flap technique as a reconstruction method of total ureteric avulsion

Indication has led ureteroscopy to be a worldwide technique, with the expected appearance of multiple complications. The ureteral avulsion is an uncommon severe urological complication of ureteroscopy (URS). Surgery in patients with a total ureteral loss is a demanding challenge for urologist. It requires usually immediate open or laparoscopic intervention. This case report was to present the treatment modality after ureteral avulsion. We have presented a case of 58-year-old male patient who underwent a successful repair of an upper ureteral injury. We have comprehensively described the effectiveness of an extended Boari-flap procedure for reconstruction after iatrogenic ureteral trauma. Particularly in an unexpected and casual situations, the presented extended Boari flap modification can be a great alternative for reconstructing a total ureteral loss. In conclusion we have recommend useful tips, how to counteract such unwanted events.

Outcome of ureteral distensibility on the success of ureteroscopy: A prospective hospital-based descriptive study

Introduction“Difficult ureter” is a known problem that increases the complications during ureteroscopy. ObjectiveTo categorize ureters according to their distensibility, and to determine whether ureteric distensibility is associated with the success of ureteroscopy and its complications. Subjects and methodsBetween January 2010 and September 2012, we tested ureteral distensibility in 306 patients who had a unilateral single radiopaque ureteral stone, 6–20mm in diameter. Ureteral distensibility was classified into two categories according to the maximum size of a ureteral dilator that could be introduced before ureteroscopy: non-distensible ureters, which admitted a dilator up to 10 Fr and distensible ureters, which admitted a dilator >10 Fr. Correlations between distensibility and the success rate and complications of ureteroscopy were determined. ResultsOverall, 102 patients (33.3%) had non-distensible ureters and 204 (66.7%) had distensible ureters. Distensibility was correlated with the success of ureteroscopy because initial ureteroscopy failed in 38.2% of non-distensible ureters. Ureteroscopy was successful in all distensible ureters. The incidence of ureteric injury was higher in non-distensible ureters than in distensible ureters. ConclusionsOur results suggest that ureteric distensibility should be tested before ureteroscopy. Primary ureteroscopy is recommended in distensible ureters because of its low complication rates and favorable outcome. Pre-stenting may be necessary before ureteroscopy in non-distensible ureters; secondary ureteroscopy may be safer and more feasible in these settings.

Indications, outcome and complications of ureteroscopy, at Gezira Hospital for renal diseases and surgery, Sudan: a seven years ‘experience

Background: Ureteroscopy (rigid and flexible) with irrigating and working channels have expanded the capability of the urologist to diagnose and treat most abnormalities of the upper tracts. Objective: This study was conducted as a part of holistic auditing to the services provided by Gezira Hospital for Renal Disease and Surgery (GHRD&S), and specifically to evaluate ureteroscopy done in GHRD&S with emphasis on the indications, outcome and complications. Methods: Across-sectional- hospital-based study was adopted. All patients who underwent ureteroscopy since the inauguration of the hospital from 2005-2011 were included. Results: The total number of patients satisfying the inclusion criteria was 472 with a mean age of 40.6 years. Male to female ratio was 1.46:1. The mean hospital stay was 2.74 days.The commonest indication for ureteroscopy was ureteric stone amounting (74%) to a tangible share of ureteric stenting or removal as indication were found in (56.8%) . and therapeutic ureteroscopy for (92.3%). Ureteric stricture was not uncommon (24%). The success rate of therapeutic ureteroscopy was (93.7%) with definite correlation to the site of pathology been (91.75%), (92.3 %) and (87.5%) for the lower, mid and upper ureter respectively. The complications recorded were bleeding (3.3%), penetration (2.5 %), post-operative colic (13%) and infection (0.4%). Mortality rate was zero Conclusion: Because the experience of ureteroscopy in GHRD&S was auspiced by regular training from the SIU the outcome is really comparable to the literature. Keywords: Ureteroscopy, Gezira Hospital for Renal Disease and Surgery, Wad Medani, Success and safety

Categorization of ureteroscopy complications and investigation of associated factors by using the modified Clavien classification system.

The purpose of the present study was to review the complications of ureteroscopy (URS) by using the modified Clavien classification system (MCCS) and to investigate the factors associated with complications. Data regarding 811 patients who underwent URS for ureteral calculus were analyzed. Peroperative and postoperative complications were recorded. The patients were divided into seven groups depending on the severity of the complications. The association of sex, stone size, number, and localization with each MCCS grade was also evaluated. The average age was 45 years. The success of the procedure after one session was 93.5%. Complications were recorded in 57.9% of the patients. According to the MCCS, grade I, II, IIIa, IIIb, IVa, IVb, and V complications were documented in 29.8%, 7.1%, 8.6%, 11%, 0%, 1.2%, and 0% of the patients, respectively. The factors associated with the complications graded by MCCS were sex, stone size, number of stones, and localization. In addition, in multivariate analysis, history of previous surgeries for urolithiasis, orifice dilatation, and instrument size were associated with complications. According to MCCS, sex, history of previous surgeries for urolithiasis, orifice dilatation, size of the instrument, stone size, number of stones, and localization are associated with different grades of complications in URS.

Is Prolonged Operation Time a Predictor for the Occurrence of Complications in Ureteroscopy?

Objective: To determine the impact of duration of ureteroscopy for urolithiasis on complication rates (CRs) of the procedure. Methods: A retrospective analysis of 2,010 patients, treated between 2006 and 2011, was done. The operation time (OT) and the occurrence of complications were compared. Results: The overall CR was 14.3% [298 complications, minor complications (Clavien I-II) 91.7%]. The median OT was 35 min [interquartile range (IQR) 20-61]. The OT differed significantly between those without complications [34 min (IQR 20-60)] and those with complications [45 min (IQR 25-76)] (p < 0.0001). The correlation between the OT and the occurrence of complications (r = -0.009648, p < 0.0001) was very weak and passed the level of significance (r = 0.2). The effect size was of minor relevance (Cohen's d = 0.27972). Conclusions: Longer OT correlates significantly with a higher CR. The effect is however shown to be minor and the overall rate of complications, especially severe ones, is low.

Reporting ureteroscopy complications using the modified clavien classification system.

Objective:Perioperative complications are one of the surrogate indicators of surgical outcomes. However, reporting these complications need a precise grading system. Our aim is to report and grade the complications of semirigid ureteroscopy in ureteral stone management according to the modified Clavien classification system.Materials and Methods:This is a prospective study conducted From January 2012 to June 2013. All patients with ureteral stones who were indicated for semirigid URS were evaluated. All procedures were performed by the same surgeon. The data recorded including patient demographics, clinical indication, stone size and location, operative time and complications were classified according to the modified Clavien classification system. The patients were followed for 8 weeks postoperatively.Results:148 patients included, Stone distribution was: 89 (60.1%) lower ureteral, 26 (17.6%) mid ureteral, and 33 (22.3%) upper ureteral. the mean stone size was 8.6 mm. Urgent URS done in 23% of patient. The overall stone free rate was 88.5%, the individual stone free rate for the upper, middle and lower ureter were 87.9%, 84.6%, and 89.9%, respectively. The mean operative time was 31.9 min (20-50 min.). Complications occurred in 26.35% of patients. Grade I complications occurred in 32 patients (26.1%), grade II in 9 (6.1%), grade IIIa in 7 (4.7%), grade IIIb in 8 (5.4%), grade IVa in two patient (1.35%), and grade IVb in one patient (0.7%). No grade V complication was encountered.Conclusion:Ureteroscopy becomes the vanguard interventional therapy for ureteral stones with well-established efficacy and safety. It is of paramount importance to adopt a precise structured classification system for reporting surgical complications, that should be flexible and comprehensive in order to accommodate the various and rapidly expanding surgical fields.

Management of complete ureteral avulsion in ureteroscopy

Ureteral 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.

Clinical outcomes after ureteroscopic lithotripsy in patients who initially presented with urosepsis: matched pair comparison with elective ureteroscopy.

The outcomes of ureteroscopy (URS) after urgent decompression and antibiotics for patients who initially present with urosepsis because of obstructive urolithiasis have not been previously evaluated. The aim of this study was to compare the outcomes and complications of URS in patients with a recent history of sepsis with those without sepsis. The study included 138 patients who underwent URS for stone removal from January 2004 to September 2011 at a university medical center. A matched-pair analysis was performed using three parameters (age, sex, and race) to compare outcomes and complications between 69 patients who had sepsis vs a matched cohort who did not have sepsis before URS. The study included 138 patients, 88 (64%) females and 50 (36%) males with a median age of 57.5 years (range 18-88 years). Patients with previous sepsis had similar patient characteristics and stone-free rates (81% vs 77%) compared with patients without previous sepsis (P>0.05). Patients with previous sepsis, however, had a significantly higher complications rate (20% vs 7%), longer hospital length of stay (LOS), and longer courses of postoperative antibiotics after URS (P<0.05). Sepsis developed postoperatively in two patients with diabetes (one with and one without previous sepsis), and postoperative fever developed in five patients with previous sepsis. URS after decompression for urolithiasis-related sepsis has similar success but higher complication rates, greater LOS, and longer course of postoperative antibiotics. This is important in counseling patients who present for definitive URS after urgent decompression for urolithiasis-related sepsis.

Possible complications of ureteroscopy in modern endourological era: two-point or "scabbard" avulsion.

Indication has led ureteroscopy to be a worldwide technique, with the expected appearance of multiple types of complications. Severe complications are possible including ureteral perforation or avulsion. Ureteral avulsion has been described as an upper urinary tract injury related to the action of blunt trauma, especially from traffic accidents, being the mechanism of injury, the result of an acute deceleration/acceleration movement. With the advent of endourology, that term is also applied to the extensive degloving injury resulting from a mechanism of stretching of the ureter that eventually breaks at the most weakened site, or ureteral avulsion is referred to as a discontinuation of the full thickness of the ureter. The paper presents a case report and literature review of the two-point or “scabbard” avulsion. The loss of long segment of the upper ureter, when end-to-end anastomosis is not technically feasible, presents a challenge to the urological surgeon. In the era of small calibre ureteroscopes these complications, due to growing incidence of renal stones will become more and more actual. Our message to other urologists is to know such a complication, to know the ways of treatment, and to analyse ureteroscopic signs, when to stop or pay attention.