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Complications of Ureteroscopy

  • Ryan B. PickensEmail author
  • Nicole L. Miller
Chapter

Abstract

Introduction: Complications in ureteroscopy (URS) occur at a low incidence and most are minor but still major complications do happen. It is the responsibility of the surgeon to be able to recognize and manage these complications whether they occur intraoperatively or postoperatively.

Discussion: URS is a major treatment modality of the modern urologist and is used for the treatment of upper tract calculi and urothelial cancer. Technologic advancements and smaller instruments have lowered the incidence of complications of URS but they still occur and in some instances can lead to significant morbidity and even mortality. URS complications can be broken down into intraoperative and postoperative categories and further broken down into major and minor complications.

Intraoperative complications include: bleeding, thermal injury, technology failure, submucosal or lost stone, ureteral perforation, ureteral avulsion, mucosal injury, and false passage. Most of these injuries are minor and easily recognized during the procedure. Usually prolonged ureteral stent placement will help heal these injuries but they can lead to strictures postoperatively so these patients must be followed with serial imaging. Ureteral avulsion typically requires a delayed sometimes complex reconstruction procedure.

Postoperative complications include: infection or sepsis, transient vesicoureteral reflux (VUR), and ureteral stricture. VUR usually resolves with just observation. Ureteral strictures can lead to loss of kidney function if not treated by either endoscopic or open/laparoscopic means. Infection and sepsis can often be prevented by preoperative and perioperative measures, but if they occur, early recognition and treatment improve outcomes.

Conclusion: Complications after ureteroscopy have a low incidence and are mostly minor but major complications can occur. Most of these complications can be treated with conservative management but some require adjuvant procedures. An important tool for any physician is the ability to recognize these complications and treat them accordingly in a safe manner that is best for the patient. Furthermore, awareness of these complications allows for understanding of the strategies employed to prevent their occurrence.

Keywords

Renal Pelvis Stricture Formation Ureteral Stricture Access Sheath Ureteral Access Sheath 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Schuster TG, Hollenbeck BK, Gaeber GJ, Wolf Jr JS. Complications of ureteroscopy: analysis of predictor factors. J Urol. 2001;166(2):538–40.PubMedCrossRefGoogle Scholar
  2. 2.
    Harmon WJ, Sershon PD, Blute ML, Patterson DE, Segura JW. Ureteroscopy: current practice and long-term complications. J Urol. 1997;157(1):28–32.PubMedCrossRefGoogle Scholar
  3. 3.
    Patel SR, McLaren ID, Nakada SY. The ureteroscope as a safety wire for ureteronephroscopy. J Endourol. 2012;26(4):351–4.PubMedCrossRefGoogle Scholar
  4. 4.
    Zattoni F. Ureteroscopy: complications. In: Smith AD, editor. Smith’s textbook of endourology. 2nd ed. Hamilton, ON: BC Decker; 2007.Google Scholar
  5. 5.
    Rehman J, Monga M, Landman J. Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology. 2003;61(4):713–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Johnson DB, Pearle MS. Complications of ureteroscopy. Urol Clin North Am. 2004;31(1):157–71.PubMedCrossRefGoogle Scholar
  7. 7.
    Blute ML, Sergura JW, Patterson DE. Ureteroscopy. J Urol. 1988;139(3):510–2.PubMedGoogle Scholar
  8. 8.
    Abdel-Razzak OM, Bagley DH. Clinical experience with flexible ureteropyeloscopy. J Urol. 1992;148:1788–92.PubMedGoogle Scholar
  9. 9.
    Meretyk I, Meretyk S, Clayman RV. Endopyelotomy: comparison of ureteroscopic retrograde and antegrade percutaneous techniques. J Urol. 1992;148(3):775–82. discussion 782–3.PubMedGoogle Scholar
  10. 10.
    Turna B, Stein RJ, Smaldone MC, et al. Safety and efficacy of flexible ureterorenoscopy and holmium:YAG lithotripsy for intrarenal stones in anticoagulated cases. J Urol. 2008;179(4):1415–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Geavlete P, Georgescu D, Niţă G, Mirciulescu V, Cauni V. Complications of 2735 retrograde semirigid ureteroscopy procedures: a single center experience. J Endourol. 2006;20(3):179–85.PubMedCrossRefGoogle Scholar
  12. 12.
    Francesca F, Scattoni V, Nava L, Pompa P, Grasso M, Rigatti P. Failures and complications of transurethral ureteroscopy in 297 cases: conventional rigid instruments vs. small caliber semirigid ureteroscopes. Eur Urol. 1995;28(2):112–5.PubMedGoogle Scholar
  13. 13.
    Başar H, Ohta N, Kageyama S, Suzuki K, Kawabe K. Treatment of ureteral and renal stone by electrohydraulic lithotripsy. Int Urol Nephrol. 1997;29(3):275–80.PubMedCrossRefGoogle Scholar
  14. 14.
    Sofer M, Watterson JD, Wollin TA, Nott L, Razvi H, Denstedt JD. Holmium:YAG laser lithotripsy for upper urinary tract calculi in 598 patients. J Urol. 2002;167(1):31–4.PubMedCrossRefGoogle Scholar
  15. 15.
    Chen GL, Bagley DH. Ureteroscopic surgery for upper tract transitional-cell carcinoma: complications and management. J Endourol. 2001;15(4):399–404. discussion 409.PubMedCrossRefGoogle Scholar
  16. 16.
    Grasso M. Ureteropyeloscopic treatment of ureteral and intrarenal calculi. Urol Clin North Am. 2000;27(4):623–31.PubMedCrossRefGoogle Scholar
  17. 17.
    Leveillee RJ, Hulbert JC. Complications. In: Smith AD, editor. Smith’s Textbook of endourology. St. Louis: Quality Medical Publishing; 1996. p. 513–25.Google Scholar
  18. 18.
    Stoller ML, Wolf JS. Endoscopic ureteral injuries. In: McAnnich JW, editor. Traumatic and reconstructive uology. Philadelphia, PA: WB Saunders; 1996. p. 199–211.Google Scholar
  19. 19.
    Jeromin L, Sosnowski M. Ureteroscopy in the treatment of ureteral stones: over ten years’ experience. Eur Urol. 1998;34(4):344–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Schuster TG, Hollenbeck BK, Faerber GJ, Wolf Jr JS. Complications of ureteroscopy: analysis of predictive factors. J Urol. 2001;166(2):538–40.PubMedCrossRefGoogle Scholar
  21. 21.
    Siddiq FM, Leveillee RJ. Complications of ureteroscopic approaches, including incisions. In: Nakada SY, Pearle MS, editors. Advanced endourology: the complete clinical guide. Totowa, NJ: Humana Press Inc; 2005. p. 299–320.Google Scholar
  22. 22.
    Grasso M, Lui JB, Goldberg B, Bagley DH. Submucosal calculi: endoscopic and intramural sonographic diagnosis and treatment options. J Urol. 1995;153(5):1384–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Kriegmair MN. Paraureteral calculi caused by ureteroscopic perforation. Urology. 1995;45(4):578–80.PubMedCrossRefGoogle Scholar
  24. 24.
    Doddamani D, Kumar R, Hemal AK. Stone granuloma–not to be forgotten as a delayed complication of ureteroscopy. Urol Int. 2002;68(2):129–31.PubMedCrossRefGoogle Scholar
  25. 25.
    Dretler SP, Young RH. Stone granuloma: a cause of ureteral stricture. J Urol. 1993;150(6):1800–2.PubMedGoogle Scholar
  26. 26.
    de la Rosetter JJ, Skrekas T, Segura JW. Handling and prevention complications in stone basketing. Eur Urol. 2006;50(5):991–8.CrossRefGoogle Scholar
  27. 27.
    Grasso M. Complications of ureteropyeloscopy. In: Taneja SS, Smith RB, Ehrlich RM, editors. Complications of urologic surgery. 3rd ed. Philadelphia, PA: Saunders; 2001. p. 268–76.Google Scholar
  28. 28.
    Abdelrahim AF, Abdelmaguid A, Abuzeid H, Amin M, Mousa el S, Abdelrahim F. Rigid ureteroscopy for ureteral stones: factors associated with intraoperative adverse events. J Endourol. 2008;22(2):277–80.PubMedCrossRefGoogle Scholar
  29. 29.
    Martin X, Ndoye A, Knoan PG, et al. Hazards of lumber ureteroscopy: apropos of 4 cases of avulsion of the ureter. Prog Urol. 1998;8(3):358–62.PubMedGoogle Scholar
  30. 30.
    Shokeir AA. Interposition of ileum in the ureter: a clinical study of long-term follow up. Br J Urol. 1997;79(3):324–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Roberts WW, Cadeddu JA, Micali S, Kavoussi LR, Moore RG. Ureteral stricture formation after removal of impacted calculi. J Urol. 1998;159(3):723–6.PubMedCrossRefGoogle Scholar
  32. 32.
    American Urologic Association [homepage on the Internet]. Baltimore: Best Practice Policy Statement on Urologic Surgery Antimicrobial Prophylaxis; 2008. (Reviewed and validity confirmed 2011, updated February 2012). AUA Guidelines for Antibiotic Prophylaxis. Available from: www.auanet.org/content/media/antimicroprop08.pdf.
  33. 33.
    Cox CE. Comparison of intravenous ciprofloxacin and intravenous cefotaxime for Antimicrobial prophylaxis in transurethral surgery. Am J Med. 1989;87(5A):252S–4.PubMedCrossRefGoogle Scholar
  34. 34.
    Gombert ME, duBouchet L, Aulicino TM, Berkowitz LB, Macchia RJ. Intravenous ciprofloxacin versus cefotaxime prophylaxis during transurethral surgery. Am J Med. 1989;87(5A):250S–1.PubMedCrossRefGoogle Scholar
  35. 35.
    Lukkarinen O, Hellström P, Leppilahti M, Kontturi M, Tammela T. Antimicrobial prophylaxis in patients with urinary retention undergoing transurethral prostatectomy. Ann Chir Gynaecol. 1997;86(3):239–42.PubMedGoogle Scholar
  36. 36.
    Christiano AP, Hollowell CM, Kim H, et al. Double-blind randomized comparison of single-dose ciprofloxacin versus intravenous cefazolin in patients undergoing outpatient endourologic surgery. Urology. 2000;55(2):182–5.PubMedCrossRefGoogle Scholar
  37. 37.
    Richter S, Shalev M, Lobik L, Buchumensky V, Nissenkorn I. Early postureteroscopy vesicoureteral reflux–a temporary and infrequent complication: prospective study. J Endourol. 1999;13(5):365–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Stoller ML, Wolf JS, Hofmann R, Marc B. Ureteroscopy without routine balloon dilation: an outcome assessment. J Urol. 1992;147(5):1238–42.PubMedGoogle Scholar
  39. 39.
    Delvecchio FC, Auge BK, Brizuela RM, et al. Assessment of stricture formation with the ureteral access sheath. Urology. 2003;61(3):518–22.PubMedCrossRefGoogle Scholar
  40. 40.
    Davis DM. Intubated ureterostomy: a new operation for ureteral and ureteropelvic strictures. Surg Gynecol Obstet. 1943;76:513.Google Scholar
  41. 41.
    Weizer AZ, Auge BK, Silverstein AD, et al. Routine postoperative imaging is important after ureteroscopic stone manipulation. J Urol. 2002;168(1):46–50.PubMedCrossRefGoogle Scholar
  42. 42.
    Alapont JM, Broseta E, Oliver F, Pontones JL, Boronat F, Jiménez-Cruz JF. Ureteral avulsion as a complication of ureteroscopy. Int Braz J Urol. 2003;29:18–22.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Urologic SurgeryVanderbilt University Medical CenterNashvilleUSA
  2. 2.Department of Urologic SurgeryVanderbilt University School of MedicineNashvilleUSA

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