Skip to main content
SpringerLink
Log in

Complications of Ureteroscopy

  • Chapter
  • First Online:
Surgical Management of Urolithiasis

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Schuster TG, Hollenbeck BK, Gaeber GJ, Wolf Jr JS. Complications of ureteroscopy: analysis of predictor factors. J Urol. 2001;166(2):538–40.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  3. Patel SR, McLaren ID, Nakada SY. The ureteroscope as a safety wire for ureteronephroscopy. J Endourol. 2012;26(4):351–4.

    Article  PubMed  Google Scholar 

  4. Zattoni F. Ureteroscopy: complications. In: Smith AD, editor. Smith’s textbook of endourology. 2nd ed. Hamilton, ON: BC Decker; 2007.

    Google Scholar 

  5. Rehman J, Monga M, Landman J. Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology. 2003;61(4):713–8.

    Article  PubMed  Google Scholar 

  6. Johnson DB, Pearle MS. Complications of ureteroscopy. Urol Clin North Am. 2004;31(1):157–71.

    Article  PubMed  Google Scholar 

  7. Blute ML, Sergura JW, Patterson DE. Ureteroscopy. J Urol. 1988;139(3):510–2.

    PubMed  CAS  Google Scholar 

  8. Abdel-Razzak OM, Bagley DH. Clinical experience with flexible ureteropyeloscopy. J Urol. 1992;148:1788–92.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  16. Grasso M. Ureteropyeloscopic treatment of ureteral and intrarenal calculi. Urol Clin North Am. 2000;27(4):623–31.

    Article  PubMed  CAS  Google Scholar 

  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. 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. Jeromin L, Sosnowski M. Ureteroscopy in the treatment of ureteral stones: over ten years’ experience. Eur Urol. 1998;34(4):344–9.

    Article  PubMed  CAS  Google Scholar 

  20. Schuster TG, Hollenbeck BK, Faerber GJ, Wolf Jr JS. Complications of ureteroscopy: analysis of predictive factors. J Urol. 2001;166(2):538–40.

    Article  PubMed  CAS  Google Scholar 

  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. 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.

    Article  PubMed  CAS  Google Scholar 

  23. Kriegmair MN. Paraureteral calculi caused by ureteroscopic perforation. Urology. 1995;45(4):578–80.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  25. Dretler SP, Young RH. Stone granuloma: a cause of ureteral stricture. J Urol. 1993;150(6):1800–2.

    PubMed  CAS  Google Scholar 

  26. de la Rosetter JJ, Skrekas T, Segura JW. Handling and prevention complications in stone basketing. Eur Urol. 2006;50(5):991–8.

    Article  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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. Cox CE. Comparison of intravenous ciprofloxacin and intravenous cefotaxime for Antimicrobial prophylaxis in transurethral surgery. Am J Med. 1989;87(5A):252S–4.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  38. Stoller ML, Wolf JS, Hofmann R, Marc B. Ureteroscopy without routine balloon dilation: an outcome assessment. J Urol. 1992;147(5):1238–42.

    PubMed  CAS  Google Scholar 

  39. Delvecchio FC, Auge BK, Brizuela RM, et al. Assessment of stricture formation with the ureteral access sheath. Urology. 2003;61(3):518–22.

    Article  PubMed  Google Scholar 

  40. Davis DM. Intubated ureterostomy: a new operation for ureteral and ureteropelvic strictures. Surg Gynecol Obstet. 1943;76:513.

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Ryan B. Pickens M.D.

  2. Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA

    Nicole L. Miller M.D.

Authors
  1. Ryan B. Pickens M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicole L. Miller M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ryan B. Pickens M.D. .

Editor information

Editors and Affiliations

  1. School of Medicine and Public Health, Department of Urology, University of Wisconsin, 1685 Highland Avenue, Madison, 53705, Wisconsin, USA

    Stephen Y. Nakada

  2. Southwestern Medical Center, Department of Urology, University of Texas, 5323 Harry Hines, Blvd, Dallas, 75390, Texas, USA

    Margaret S. Pearle

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Pickens, R.B., Miller, N.L. (2013). Complications of Ureteroscopy. In: Nakada, S., Pearle, M. (eds) Surgical Management of Urolithiasis. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6937-7_11

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-6937-7_11

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6936-0

  • Online ISBN: 978-1-4614-6937-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation