Advertisement

Ureteroscopy pp 141-150 | Cite as

Postoperative Care of the Ureteroscopy Patient

  • Itay M. Sabler
  • Ioannis Katafygiotis
  • Mordechai Duvdevani
Chapter

Abstract

Ureteroscopy (URS) is the first-line therapy for ureteral and renal stones. Stone-free status may be as high as 90–100%. In parallel to high stone-free rates and the use of miniaturized flexible instruments, the postoperative complication rates still remain a major issue. The postoperative care of the patient submitted to ureteroscopy depends on the type of instrumentation (rigid, flexible), on the size of the ureteroscope, on the type of the procedure (diagnostic, therapeutic for stone or tumor), on the anatomic location the procedure is focused (ureter or kidney), the duration of the operation, the use or not of upper urinary tract drainage, and finally on the occurrence of intraoperative complications. The main issues to consider during the postoperative course are the infections, including sepsis-SIRS, pain management, perirenal hematoma, initial imaging, obstruction and upper urinary tract drainage, and postoperative antibiotic administration. Apart from the administration of antibiotics and perhaps the use of a stent, there are not specific guidelines for the postoperative care of the ureteroscopy patient, and more studies are needed in order a standardized protocol to be proposed.

Keywords

Αntibiotics Complications Endourology Follow-up of the ureteroscopy Infections Obstruction Pain management Postoperative care of the ureteroscopy patient Retrograde intrarenal surgery Sepsis Upper urinary tract drainage Ureteroscopy 

Abbreviations

CT

Computer tomography

DJS

Double-J stent

MET

Medical expulsive therapy

NSAIDs

Nonsteroidal anti-inflammatory drugs

PCNL

Percutaneous nephrolithotomy

PRH

Perirenal hematoma

SFR

Stone-free rate

SWL

Shock wave lithotripsy

UC

Ureter catheter

URS

Ureteroscopy

References

  1. 1.
    Tan HJ, Strope SA, He C, Roberts WW, Faerber GJ, Wolf JS. Jr immediate unplanned hospital admission after outpatient ureteroscopy for stone disease. J Urol. 2011;185:2181–5.CrossRefGoogle Scholar
  2. 2.
    Pearle MS, Calhoun EA, Curhan GC, Urologic diseases of America Project. Urologic diseases in America project: urolithiasis. J Urol. 2005;173:848–57.CrossRefGoogle Scholar
  3. 3.
    Cheung MC, Lee F, Leung YL, Wong BB, Chu SM, Tam PC. Outpatient ureterscopy: predictive factors for postoperative events. Urology. 2001;58:914–8.CrossRefGoogle Scholar
  4. 4.
    Bromwich EJ, Lockyer R, Keoghane SR. Day-case rigid and flexible ureteroscopy. Ann R Coll Surg Engl. 2007;89:526–8.CrossRefGoogle Scholar
  5. 5.
    Lo CW, et al. Effectiveness of prophylactic antibiotics against post-ureteroscopic lithotripsy infections: systematic review and meta-analysis. Surg Infect (Larchmt). 2015;16:415–20.CrossRefGoogle Scholar
  6. 6.
    Wagenlehner FM, Lichtenstern C, Rolfes C, et al. Diagnosis and management for urosepsis. Int J Urol. 2013;20:963–70.Google Scholar
  7. 7.
    Somani BK, Giusti G, Sun Y, et al. Complications associated with ureterorenoscopy (URS) related to the treatment of urolithiasis: the clinical research office of endourological society URS global study. World J Urol. 2017;35(4):675–81.CrossRefGoogle Scholar
  8. 8.
    Pearle MS, Pierce HL, Miller GL, et al. Optimal method of urgent decompression of the collecting system for obstruction and infection due to ureteral calculi. J Urol. 1998;160:1260–4.CrossRefGoogle Scholar
  9. 9.
    Ramy F, Youssef MD, Andreas Neisius MD, Zachariah G, et al. Clinical outcomes after ureteroscopic lithotripsy in patients who initially presented with urosepsis: matched pair comparison with elective ureteroscopy. J Endourol. 2014;28(12):1439–43.CrossRefGoogle Scholar
  10. 10.
    Whitehurst LA, Somani BK. Perirenal hematoma after ureteroscopy: a systematic review. J Endourol. 2017;31(5):438–45.CrossRefGoogle Scholar
  11. 11.
    Pathan SA, et al. Delivering safe and effective analgesia for management of renal colic in the emergency department: a double-blind, multigroup, randomised controlled trial. Lancet. 2016;387(10032):1999–2007. https://www.ncbi.nlm.nih.gov/pu CrossRefGoogle Scholar
  12. 12.
    Türk C, Neisius A, Petrik A, Seitz C, Skolarikos A, Tepeler A, et al. EUA Nephrolithiasis guidelines 2017. Retrieved from: https://uroweb.org/guideline/2017. Nephrolithiasis guidelines/accessed 11.06.2017.
  13. 13.
    Krum H, et al. Blood pressure and cardiovascular outcomes in patients taking nonsteroidal nti-inflammatory drugs. Cardiovasc Ther. 2012;30(6):342–50.CrossRefGoogle Scholar
  14. 14.
    Bhala N, et al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013;382(9894):769–79.CrossRefGoogle Scholar
  15. 15.
    Holdgate A, et al. Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic. BMJ. 2004;328(7453):1401.CrossRefGoogle Scholar
  16. 16.
    Hollingsworth JM, et al. Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. BMJ. 2016;355:i6112.CrossRefGoogle Scholar
  17. 17.
    Hamidi N, Ozturk E, Yikilmaz TN, Atmaca AF, Basar H. The effect of corticosteroid on postoperative early pain, renal colic and total analgesic consumption after uncomplicated and unstented ureteroscopy: a matched-pair analysis. World J Urol. 2018;36(6):979–84.CrossRefGoogle Scholar
  18. 18.
    Assimos D, et al. Preoperative JJ stent placement in ureteric and renal stone treatment: results from the Clinical Research Office of Endourological Society (CROES) ureteroscopy (URS) Global Study. BJU Int. 2016;117:648.CrossRefGoogle Scholar
  19. 19.
    Song T, et al. Meta-analysis of postoperatively stenting or not in patients underwent ureteroscopic lithotripsy. Urol Res. 2012;40(1):67–77.CrossRefGoogle Scholar
  20. 20.
    Chen YT, Chen J, Wong WY, Yang SS, Hsieh CH, Wang CC. Is ureteral stenting necessary after uncomplicated ureteroscopic lithotripsy? A prospective, randomized controlled trial. J Urol. 2002;167(5):1977–80.CrossRefGoogle Scholar
  21. 21.
    Gettman MT, Segura JW. Management of ureteric stones: issues and controversies. BJU Int. 2005;95:85–93.CrossRefGoogle Scholar
  22. 22.
    Gunlusoy B, Degermenci T, Arslan M, et al. Is ureteral catheterization necessary after ureteroscopic lithotripsy for uncomplicated upper ureteral stones? J Endourol. 2008;22:1645.CrossRefGoogle Scholar
  23. 23.
    Shen P, Li Y, Yang J, et al. The results of ureteral stenting after uretroscopic lithotripsy for ureteral calculi: a systematic review and meta-analysis. J Urol. 2011;186:1904–9.CrossRefGoogle Scholar
  24. 24.
    Denstedt JD, Wollin TA, Sofer M, et al. A prospective randomized controlled trial comparing nonstented versus stented ureteroscopic lithotripsy. J Urol. 2001;165:1419–22.CrossRefGoogle Scholar
  25. 25.
    Pengfei S, Yutao L, Jie Y, et al. The results of ureteral stenting after ureteroscopic lithotripsy for ureteral calculi: a systematic review and meta-analysis. J Urol. 2011;186:1904–9.CrossRefGoogle Scholar
  26. 26.
    Knudsen BE, Beiko DT, Denstedt JD, et al. Stenting after ureteroscopy: pros and cons. Urol Clin North Am. 2004;31:173–80.CrossRefGoogle Scholar
  27. 27.
    Wang H, Man L, Li G, et al. Meta-analysis of stenting versus non-stenting for the treatment of ureteral stones. PLoS One. 2017;12(1):e0167670.CrossRefGoogle Scholar
  28. 28.
    Sabler IM, et al. Does retrograde treatment of upper urinary tract stones necessitate postoperative upper urinary tract drainage? Conclusions from over 500 single center consecutive cases. J Endourol. 2018;32(6):477–81.CrossRefGoogle Scholar
  29. 29.
    Knopf HJ, Graff HJ, Schulze H. Perioperative antibiotic prophylaxis in ureteroscopic stone removal. Eur Urol. 2003;44(1):115–8.CrossRefGoogle Scholar
  30. 30.
    Wilson W, Taubert K, Gewitz M, et al. Prevention of Infective Endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007;116:1736–54.CrossRefGoogle Scholar
  31. 31.
    Mariappan P, et al. Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study. J Urol. 2005;173:1610.CrossRefGoogle Scholar
  32. 32.
    Gravas S, et al. Postoperative infection rates in low risk patients undergoing percutaneous nephrolithotomy with and without antibiotic prophylaxis: a matched case control study. J Urol. 2012;188:843.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Itay M. Sabler
    • 1
  • Ioannis Katafygiotis
    • 1
  • Mordechai Duvdevani
    • 1
  1. 1.Department of UrologyHadassah Hebrew University Medical CenterJerusalemIsrael

Personalised recommendations