Revisiting the predictive factors for intra-operative complications of rigid ureteroscopy: a 15-year experience (original) (raw)
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The Medical Journal of Cairo University, 2018
Background: Management of urolithiasis varies from simple clinical observation and medical expulsive therapy to the use of refined endourologic techniques to extract the stone. The therapeutic technique currently available comprises ureteroscopy with or without the need for intracorporeal lithotripsy, percutaneous therapy, (PCNL) Extracorporeal Shock Wave Lithotripsy (ESWL), and surgical modalities (4,5). Objective: Urolithiasis (UL) is one of the most common diseases, with worldwide increasing incidence and prevalence. Aim of the Work: Was to report the hazards of Flexible Ureteroscopy (FURS), the re-treatment rate and its complication outcomes for the treatment of renal and ureteral calculi during the learning curve. Patients and Methods: This study was conducted prospectively on forty patients divided into two groups; Group I (ureteric stone group) and Group II (renal stone group)to compare the complications after the introduction of FURS. They underwent FURS and Holmium: YAG laser lithotripsy. The complications were classified using modified stave and the Clavien system (I-IV). Results: The mean patient age in the total procedures was 45.63 ± 10.98 years (range 27.0-62.0 years), and the mean stone size was 1.36±0.37cm (range 0.6-2cm). Group I: Mean stone size 1.36 ±0.37cm, the stone free rate for all cases was 77.3% (100% for stones <1.5cm and 50% for stones ≥ 1.5cm). The overall intra-operative complications rate in all cases was 27.2% (8.3% for stones <1.5 and 50% for stone size ≥ 1.5cm). The overall post-operative complications rate was 27.4% (9% for stones <1.5cm and 60% for stones ≥ 1.5cm. Group II: The mean stone size 1.46 ±0.31, the stone free for all cases was 44.4% (70.0% for stones <1.5cm and 12.5%. for stones ≥ 1.5cm. The overall intra-operative complications rate in all cases was 72.2% (52% for stones <1.5cm and 100% for stones size ≥ 1.5cm. The overall post-operative
Rigid Ureteroscopy for Ureteral Stones: Factors Associated with Intraoperative Adverse Events
Purpose: To analyze some of the factors that may be associated with a higher incidence of complications during management of ureteral stones by rigid ureteroscopy. Patients and Methods: We reviewed all ureteroscopic interventions aimed at stone extraction and/or fragmentation in our institution from 2001 through 2005. A total of 442 interventions were eligible for inclusion. Our focus was concentrated on (1) patient characteristics (age, gender, duration of symptoms, history of uri-nary schistosomiasis, and history of surgery involving the affected ureter), (2) stone characteristics (number, length, width, and level of the ureter affected), (3) the affected reno-ureteral unit (which side was affected, the kidney's ability to excrete contrast medium, and the status of the ureter proximal and distal to the stone), and finally (4) experience level of the surgeon in charge (junior v senior). The occurrence of intraoperative adverse events was considered a dependent variable and was statistically related to each of the above factors as independent variables. Results: Intraoperative adverse events were encountered in 121 interventions including stone migration in 54, minor mucosal injuries in 24, ureteral perforation in 12, ureteral avulsion in 2, and aborted procedure due to bleeding or edema in 29. Symptomatology present for more than 3 months, a negative history of schis-tosomiasis, a positive history of ureteral surgery, stones above the ischial spines, stones 5 mm in width, a dilated proximal ureter, kidneys that failed to excrete contrast medium, and involvement of a more junior urologist were factors that were associated with a statistically significantly higher incidence of intraoperative complications. Conclusions: Rigid ureteroscopic stone manipulation remains a procedure that should be handled cautiously. Existence of any of the above risk factors should alert urologists, particularly at training centers, to adopt all possible precautionary measures.
Arab journal of urology, 2013
To analyse and compare the effect of stone site and size, method of lithotripsy, and level of experience on the results and complications of semi-rigid ureteroscopy for ureteric and renal pelvic stones. Between April 2010 and May 2011, 90 patients underwent 95 ureteroscopies, using 7.5- and 9-F semi-rigid ureteroscopes, with or without pneumatic or laser lithotripsy. The peri-operative findings were analysed and compared. The mean (SD) longest diameter of the stones was 11.8 (4.5) mm. Laser lithotripsy was used in 32 cases and pneumatic lithotripsy in 26. There were complications in 35 procedures in the form of colicky pain (2%), haematuria (1%), stone migration (7%), equipment failure (5%), access failure (8%), mucosal injury (7%), fever (2%) and extravasation (3%).The calculi were successfully retrieved in 75 patients (83%). The success rate was 95%, 77%, 85%, and 53% in the lower, middle, upper ureter and renal pelvis, respectively. Upper ureteric stones can be managed safely wit...
Combined ureterorenoscopy for ureteral and renal calculi is not associated with adverse outcomes
Central European journal of urology, 2015
We intended to evaluate the feasibility and effectiveness of the simultaneous rigid and flexible ureteroscopic treatment of symptomatic ureteral and ipsilateral small simultaneous calyceal stones. Outcomes of combined therapy were compared with monotherapy alone. In this retrospective study, group 1 consisted of 45 patients with middle or lower ureteral and ipsilateral small simultaneous calyceal stones treated by combined therapy. Group 2 included 45 patients with middle or lower ureteral stones only and treated by monotherapy. Stone characteristics, operative time, hospital stay, stone free rates, and complications were compared between groups 1 and 2. Stone free status was defined as no fragments and/or the presence of asymptomatic fragments smaller than 4 mm. Mean BMI were 29.3 ±0.9 kg/m(2) and 27.6 ±0.6 kg/m(2) in groups 1 and 2, respectively. Mean ureteral stone size (7.6 ±0.4 mm vs. 8.0 ±0.4 mm, p = 0.261) and ureteral stone burden (56.0 ±5.5 mm(2) vs. 54.8 ±6.1 mm(2), p = 0....
Efficacy and Safety of Emergency Ureteroscopic Management of Ureteral Calculi
Korean Journal of Urology, 2012
Purpose: To evaluate the efficacy and safety of the ureteroscopic management of ureteral stones immediately after a first colic attack. Materials and Methods: We retrospectively analyzed the data of 226 patients with obstructive ureteral stones who underwent ureteroscopy with stone retrieval. The 67 patients in group A underwent ureteroscopy within 48 hours of admission to our emergency department, whereas the 159 patients in group B underwent ureteroscopy more than 48 hours after admission. The chi-square test was used to evaluate and compare stone-free status, auxiliary procedures, and complications and the Kruskal-Wallis and Fisher's exact tests were used to analyze qualitative data. Results: Mean stone sizes in groups A and B were 2.41±1.62 mm and 4.11±2.64 mm, respectively. No patient experienced a major complication during or after the procedure. Stone-free rates were 89.55% and 89.93%, respectively. Conclusions: Emergency ureteroscopy in cases of obstructive ureteral stones is both safe and effective and offers the advantages of immediate stone fragmentation and the relief of acute-onset colic pain.
CT Classification of Ureteral Calculi Parameters for Predicting Ureteroscopy Complications
Purpose: The primary objective was to determine if there was a pattern of computed tomography (CT) imaging characteristics that could predict complications and outcomes from ureteroscopy for removal of ureteral calculi.Materials and Methods: A retrospective analysis of CT scan parameters on two-hundred-fifty subjects that had previously undergone ureteroscopy for treatment of ureteral calculi. Ninety-eight patients met the inclusion criteria and were subsuquently included in final analyses. Results: Stone size greater than 0.67 centimeters and location in the proximal ureter were found to be statistically significant in predicting complications. When individualizing operative complications with stone characteristics, a stone density of 817 Hounsfield units (HU) or greater, stone size of 0.79 centimeters or greater, and operative time greater than 53 minutes all showed statistical significance for the presence of hematuria. Based on multivariate logistic regression, stones in the proximal 1/3 of the ureter were more likely to get complications than stones located in the middle and lower ureter with a hazard ratio of 4.3. Conclusion: Pre-operative CT scan parameters can be a valuable asset in predicting intra-operative and post-operative complications. Stone size, location, and density appear to be independent risk factors for predicting operative ureteroscopic complications. CT scan interpretation in the pre-surgical setting is a vital tool in assessing risk and preventing complications related to the treatment of ureterolithiasis using URS.
Scandinavian Journal of Urology and Nephrology, 2011
Objective. To determine factors affecting the success of bilateral same-session ureteroscopy (BSU) in the treatment of ureteral calculi. Material and methods. From January 2003 to December 2008, BSU was carried out in 89 patients (178 renal units). A successful outcome was considered when both ureters were free of stones without intraoperative complications. Stone-free rate was evaluated with a kidney-ureter-bladder plain X-ray or non-contrast computed tomography. Factors interfering with successful completion of BSU were tested using univariate (chi-squared test and t test) and multivariate (logistic regression) analyses. Data on unilateral ureteroscopy for the treatment of multiple ureteral calculi carried out in 105 patients during the same period were compared with BSU. Results. Intraoperative complications were recorded in 11 procedures (6.2%) in the form of ureteral perforation in three and mucosal injury in eight. After BSU, 153 renal units were stone free (86%) as 17 had residual fragments, stones migrated to the kidney in six and failure was encountered in two. A successful outcome was observed in 62 patients (70%). Stone impaction, stones located in the proximal ureter and stone surface area were the significant risk factors for unsuccessful BSU (relative risks 3.6, 3.3 and 1.47, respectively). Compared with unilateral ureteroscopy, no difference were found with regard to complication rate (6.7%, p = 0.5) or stone-free rate (80%, p = 0.2). Conclusions. Bilateral same-session ureteroscopy is a safe and effective procedure in the management of bilateral ureteral stones. Proximal ureteral calculi, large and impacted stones carry the highest risk of unsuccessful results.
Results with 7.5F versus 10F rigid ureteroscopes in treatment of ureteral calculi
Urology, 2004
Objectives. To compare the success and complication rates in the treatment of ureteral stones with a 7.5F versus a 10F ureteroscope. Methods. A total of 100 patients who were scheduled for ureteroscopy to treat ureteral calculi between December 2000 and December 2002 were randomly assigned to procedures with a 7.5F (group 1; n ϭ 50) or 10F (group 2; n ϭ 50) ureteroscope. The group results were compared. Results. Group 1 had 36 distal, 9 middle, and 5 proximal ureteral stones. Group 2 had 37 distal, 6 middle, and 7 proximal ureteral stones. No statistically significant differences were noted between the two groups with respect to the mean stone size or operation time (P ϭ 0.175 and P ϭ 0.636, respectively). Pneumatic lithotripsy was used in 62% and 50% of the procedures in group 1 and 2, respectively, and stones or fragments were retrieved with basket catheters in 92% and 76% of the group procedures, respectively. The difference between the group rates for successful basket catheter extraction was statistically significant (P ϭ 0.029). Of the patients in group 1 and 2, 84% and 80%, respectively, were stone free after a single procedure (P ϭ 0.603). The corresponding failure rates in the two groups were 6% and 12% (P ϭ 0.295), and the corresponding early and late complication rates in the two groups were 6% and 4% (P ϭ 0.646). None of the patients in group 1 developed late complications. One individual (2%) in group 2 developed ureteral stenosis during long-term follow-up (P ϭ 0.315). Conclusions. The success and failure rates revealed better outcomes for treatment of ureteral calculi with a 7.5F ureteroscope, but the differences were not statistically significant. The complication rates were similar between the two groups. Basket catheters were used more frequently with the 7.5F scope, and the rates of in situ lithotripsy and postoperative ureteral stent placement were also greater in patients treated with this instrument.