Intraoperative Complications after 8150 Semirigid Ureteroscopies for Ureteral Lithiasis: Risk Analysis and Management
D. Georgescu, R. Mulţescu, B. Geavlete, P. GeavleteOriginal article, no. 3, 2014
Objectives: To evaluate semirigid retrograde ureteroscopycomplications on a significant series of patients and to establishthe factors associated with the occurrence of intraoperativecomplications.Patients and Methods: Between June 1994 and June 2013, 8150semirigid ureteroscopic procedures for ureteral lithiasis wereperformed in 7456 patients. We used semirigid ureteroscopes(8 9.8F Wolf, 8 and 10F Storz, Olympus Endoeye digital 8.5 9.9F). Lithotripsy was done with pneumatic, electrohydraulic orHo:YAG laser lithotripters. The preoperative parametersincluding gender, calculi location and size, impaction, degree ofhydronephrosis, stone number and associated malformation aswell as intraoperative aspects (stone extractors, fragmentationdevices, operative time and surgeon experience) were evaluatedin relation with complications’ rate.Results: The stone-free rate after a single ureteroscopicprocedure was 90.9%. Intraoperative incidents occurred in348 cases (4.3%). The overall rate of intraoperative complications was 2.8% (228 cases). These were represented bylesions of the ureteral mucosa (139 cases), perforation (58cases), bleeding (16 cases), ureteral avulsion (3 cases) andextra-ureteral stone migration (12 cases). Statistical analysisshows a significant association between the complicationrate on the one hand and stone size, location and impaction,operative time and surgeon experience on the other hand.Conclusions: Due to technological advances and increasedexperience, the semirigid retrograde ureteroscopic treatmentof ureteral lithiasis increased efficacy, while the incidence ofintraoperative complications decreased. Most of thesecomplications are minor and can be managed by conservativeapproach.
