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Minerva Urologica e Nefrologica 2017 October;69(5):421-31

DOI: 10.23736/S0393-2249.17.02787-4


language: English

Life-threatening complications after ureteroscopy for urinary stones: survey and systematic literature review

Luca CINDOLO 1, Pietro CASTELLAN 1 , Giulia PRIMICERI 2, Andras HOZNEK 3, Cecilia M. CRACCO 4, Cesare M. SCOFFONE 4, Antonio GALFANO 5, Giovanni PETRALIA 5, Michele DE ANGELIS 6, Filippo ANNINO 6, Emilio MALACASA 7, Luigi CORMIO 8, Pietro ACQUATI 9, Elisa DE LORENZIS 9, Orazio MAUGERI 10, Giuseppe ARENA 10, Antonio CELIA 11, Guido GIUSTI 12, Luigi SCHIPS 1

1 Department of Urology, ASL2 Abruzzo, Chieti, Italy; 2 Department of Urology, G. D’Annunzio University, Chieti, Italy; 3 Department of Urology, Henri Mondor Hospital, Créteil, France; 4 Department of Urology, Cottolengo Hospital, Turin, Italy; 5 Department of Urology, Niguarda Ca’ Granda Hospital, Milan, Italy; 6 Department of Urology, San Donato Hospital, Arezzo, Italy; 7 Department of Urology, Umberto I Hospital, Enna, Italy; 8 Department of Urology, Ospedali Riuniti, Foggia, Italy; 9 Department of Urology, Ca’ Granda and Maggiore Polyclinic Hospital, Foundation, and Institute for Research and Care, Milan, Italy; 10 Department of Urology, Santa Croce Hospital, Cuneo, Italy; 11 Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy; 12 Department of Urology, San Raffaele Hospital and Institute for Research and Care, Milan, Italy


INTRODUCTION: Retrograde ureteroscopy (URS) has become a common procedure for the management of urinary stones. Although its efficacy and safety are well known, the literature about major complications is still poor. This study highlighted some cases of life-threatening complications after semi-rigid ureteroscopy (s-URS) or flexible ureteroscopy (f-URS).
EVIDENCE ACQUISITION: Experienced endourologists (more than 75 cases/year in the last 3 years) we enrolled, and a survey was performed asking to review their series and report the cases encumbered by major complications (Clavien-Dindo IIIb-IV grade). A literature search was also conducted in the Medline (PubMed) and Cochrane Libraries databases in July, 2016 to identify all studies reporting the presence of major complications in patients underwent URS procedures. A PubMed search was performed using the following key words in combination: “kidney injury,” “ureteroscopy,” “nephrectomy,” “life-threatening,” “urinary stones,” “complications.”
EVIDENCE SYNTHESIS: Eleven urologists reported on 12 major complications (4 after s-URS, 8 after f-URS). Eight patients developed a kidney injury, 1 an arteriovenous fistula, 2 a ureter avulsion and 1 acute sepsis. Six patients underwent open nephrectomy, two surgical repair, one open pyeloplasty, one coil artery embolization and two superselective artery embolization.
CONCLUSIONS: Guidelines and clinical practice give useful recommendations about intraoperative safety and prevention of life-threatening events. The careful postoperative observation and the surgical active treatment of this complications play a key role in reducing morbidity, kidney loss and mortality. This study encourages a strict and active care of patients, supports a routine reporting of complications, and highlights the need for systematic use of standardized classification systems.

KEY WORDS: Acute kidney injury - Ureteroscopy - Nephrectomy - Postoperative complications - Urinary calculi

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