Advertisement

Ureteroscopy pp 419-434 | Cite as

Complications of Ureteroscopy

  • David A. Leavitt
  • J. Kyle AndersonEmail author
  • Sean P. Elliott
Chapter
Part of the Current Clinical Urology book series (CCU)

Abstract

Ureteroscopy is used with increasing regularity to diagnose and treat myriad upper urinary tract pathologies. Advances and miniaturization in the design of ureteroscopes and their accessory instruments combined with sound ureteroscopic technique make modern ureteroscopy quite safe. However, complications of ureteroscopy still do occur and can result in severe ureteral injury and possible kidney loss. There exists no standardized classification system to report complications of ureteroscopy and so determining exact incidences of these complications is difficult.

The vast majority of complications is minor and usually requires little more than ureteral stenting and time. Major ureteroscopic misadventures are considered those that are life threatening or require further open or laparoscopic surgical repair. Overall major complications of ureteroscopy happen infrequently and the incidence appears to be decreasing. Major ureteral injuries are usually recognized during ureteroscopy and allow for prompt management. The preferred approach to the repair of major ureteral injuries depends on the nature of the injury and its length and location.

Proper technique and familiarity with the various ureteroscopes and accessories is important to minimizing the complications of ureteroscopy. A thorough understanding of the different possible complications and predisposing risk factors can help to anticipate and avoid these complications. Appropriate and timely management of complications when they do arise is a crucial step to safe and successful ureteroscopy.

Keywords

Ureteral Stone Ureteral Injury Ureteropelvic Junction Ureteral Stenting Ureteral Stricture 
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.
    Young HH, McKay RW. Congenital valvular obstruction of the prostatic urethra. Surg Gynecol Obstet. 1929;48:509–35.Google Scholar
  2. 2.
    Grasso M. Complications of ureteropyeloscopy. In: Taneja SS, Smith RB, Ehrlich RM, editors. Complications of urologic surgery. 3rd ed. Philadelphia: WB Saunders; 2001. p. 268–76.Google Scholar
  3. 3.
    Stoller ML, Wolf JS. Ensoscopic ureteral injuries. In: McAninch JW, editor. Traumatic and reconstructive urology. Philadelphia: WB Saunders; 1996. p. 199–211.Google Scholar
  4. 4.
    Geavlete P, Georgescu D, Niţa 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
  5. 5.
    Krambeck AE, Murat FJ, Gettman MT, Chow GK, Patterson DE, Segura JW. The evolution of ureteroscopy: a modern single-institution series. Mayo Clin Proc. 2006;81(4):468–73.PubMedCrossRefGoogle Scholar
  6. 6.
    Rioja J, Mamoulakis C, Sodha H, Suwijn S, Laguna P, de la Rosette J. A Plea for centralized care for ureteroscopy: results from a comparative study under different conditions within the same center. J Endourol. 2011;25(3):425–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Schuster TG, Hollenbeck BK, Faerber GJ, Wolf JS. Complications of ureteroscopy: analysis of predictive factors. J Urol. 2001;166(2):538–40.PubMedCrossRefGoogle Scholar
  8. 8.
    Cetti RJ, Biers S, Keoghane SR. The difficult ureter: what is the incidence of pre-stenting? Ann R Coll Surg Engl. 2011;93(1):31–3.PubMedCrossRefGoogle Scholar
  9. 9.
    Flam TA, Malone JM, Roth RA. Complications of ureteroscopy. Urol Clin North Am. 1988;15(2):167–81.PubMedGoogle Scholar
  10. 10.
    Abdel-Razzak OM, Bagley DH. Clinical experience with flexible ureteropyeloscopy. J Urol. 1992;148(6):1788–92.PubMedGoogle Scholar
  11. 11.
    Blute ML, Segura JW, Patterson DE. Ureteroscopy. J Urol. 1988;139(3):510–2.PubMedGoogle Scholar
  12. 12.
    Grasso M. Ureteropyeloscopic treatment of ureteral and intrarenal calculi. Urol Clin North Am. 2000;27(4):623–31.PubMedCrossRefGoogle Scholar
  13. 13.
    Tiplitsky SI, Milhoua PM, Patel MB, Minsky L, Hoenig DM. Case report: intrarenal arteriovenous fistula after ureteroscopic stone extraction with holmium laser lithotripsy. J Endourol. 2007;21(5):530–2.PubMedCrossRefGoogle Scholar
  14. 14.
    Watterson JD, Girvan AR, Cook AJ, Beiko DT, Nott L, Auge BK, Preminger GM, Denstedt JD. Safety and efficacy of holmium: YAG laser lithotripsy in patients with bleeding diatheses. J Urol. 2002;168(2):442–5.PubMedCrossRefGoogle Scholar
  15. 15.
    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
  16. 16.
    Başar H, Ohta N, Kageyama S, Suzuki K, Kawabe K. Treatment of ureteral and renal stones by electrohydraulic lithotripsy. Int Urol Nephrol. 1997;29(3):275–80.PubMedCrossRefGoogle Scholar
  17. 17.
    Teichman JM, Rao RD, Rogenes VJ, Harris JM. Ureteroscopic management of ureteral calculi: electrohydraulic versus holmium:YAG lithotripsy. J Urol. 1997;158(4):1357–61.PubMedCrossRefGoogle Scholar
  18. 18.
    Johnson DB, Pearle MS. Complications of ureteroscopy. Urol Clin North Am. 2004;31(1):157–71.PubMedCrossRefGoogle Scholar
  19. 19.
    de la Rosette JJ, Skrekas T, Segura JW. Handling and prevention of complications in stone basketing. Eur Urol. 2006;50(5):991–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Landman J, Lee DI, Lee C, Monga M. Evaluation of overall costs of currently available small flexible ureteroscopes. Urology. 2003;62(2):218–22.PubMedCrossRefGoogle Scholar
  21. 21.
    Knudsen B, Miyaoka R, Shah K, Holden T, Turk TM, Pedro RN, Kriedberg C, Hinck B, Ortiz-Alvarado O, Monga M. Durability of the next-generation flexible fiberoptic ureteroscopes: a randomized prospective multi-institutional clinical trial. Urology. 2010;75(3):534–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Pietrow PK, Auge BK, Delvecchio FC, Silverstein AD, Weizer AZ, Albala DM, Preminger GM. Techniques to maximize flexible ureterscope longevity. Urology. 2002;60(5):784–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Sung JC, Springhart WP, Marguet CG, L’Esperance JO, Tan YH, Albala DM, Preminger GM. Location and etiology of flexible and semirigid ureteroscope damage. Urology. 2005;66(5):958–63.PubMedCrossRefGoogle Scholar
  24. 24.
    Semins MJ, George S, Allaf ME, Matlaga BR. Ureteroscope cleaning and sterilization by the urology operating room team: the effect on repair costs. J Endourol. 2009;23(6):903–5.PubMedCrossRefGoogle Scholar
  25. 25.
    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
  26. 26.
    Lytton B, Weiss RM, Green DF. Complications of ureteral endoscopy. J Urol. 1987;137(4):649–53.PubMedGoogle Scholar
  27. 27.
    Weinberg JJ, Ansong K, Smith AD. Complications of ureteroscopy in relation to experience: report of survey and author experience. J Urol. 1987;137(3):384–5.PubMedGoogle Scholar
  28. 28.
    Evans CP, Stoller ML. The fate of the iatrogenic retroperitoneal stone. J Urol. 1993;150(3):827–9.PubMedGoogle Scholar
  29. 29.
    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
  30. 30.
    Butler MR, Power RE, Thornhill JA, Ahmad I, McLornan I, McDermott T, Grainger R. An audit of 2273 ureteroscopies–a focus on intra-operative complications to justify proactive management of ureteric calculi. Surgeon. 2004;2(1):42–6.PubMedCrossRefGoogle Scholar
  31. 31.
    Jeromin L, Sosnowski M. Ureteroscopy in the treatment of ureteral stones: over 10 years’ experience. Eur Urol. 1998;34(4):344–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Bernhard PH, Reddy PK. Retrograde ureteral intussusception: a rare complication. J Endourol. 1996;10(4):349–51.PubMedCrossRefGoogle Scholar
  33. 33.
    Park J, Siegel C, Moll M, Konnak J. Retrograde ureteral intussusception. J Urol. 1994;151(4):997–8.PubMedGoogle Scholar
  34. 34.
    Compton JS, Drummond M. Intussusception of the ureter by a polypoid transitional cell carcinoma. Br J Urol. 1986;58(6):725–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Mazer MJ, Lacy SS, Kao L. “Bell-shaped ureter”, a radiographic sign of antegrade intussusception. Urol Radiol. 1979;1(1):63–5.PubMedCrossRefGoogle Scholar
  36. 36.
    Xu W, Yu CS, Yang L, Li KC. Ureteral intussusception due to a polyp. Abdom Imaging. 2007;32(5):675–7.PubMedCrossRefGoogle Scholar
  37. 37.
    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(1):18–22.PubMedCrossRefGoogle Scholar
  38. 38.
    Ordon M, Schuler TD, Honey RJ. Ureteral avulsion during contemporary ureteroscopic stone management: “the scabbard avulsion”. J Endourol. 2011;25(8):1259–62.PubMedCrossRefGoogle Scholar
  39. 39.
    Stoller ML, Wolf Jr JS, Hofmann R, Marc B. Ureteroscopy without routine balloon dilation: an outcome assessment. Urol. 1992;147(5):1238–42.Google Scholar
  40. 40.
    Tanriverdi O, Yencilek F, Koyuncu H, Yencilek E, Sarica K. Emergent stenting after uncomplicated ureteroscopy: evaluation of 23 patients. Urology. 2011;77(2):305–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Pengfei S, Yutao L, Jie Y, Wuran W, Yi D, Hao Z, Jia W. The results of ureteral stenting after ureteroscopic lithotripsy for ureteral calculi: a systematic review and meta-analysis. J Urol. 2011;186(5):1904–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Nabi G, Cook J, N’Dow J, McClinton S. Outcomes of stenting after uncomplicated ureteroscopy: ­systematic review and meta-analysis. BMJ. 2007;334(7593):572.PubMedCrossRefGoogle Scholar
  43. 43.
    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
  44. 44.
    Netto Jr NR, de Almeida Claro J, Esteves SC, Amdrade EFM. Ureteroscopic stone removal in the distal ureter. Why Change? J Urol. 1997;157(6):2081–3.CrossRefGoogle Scholar
  45. 45.
    Puppo P, Ricciotti G, Bozzo W, Introini C. Primary endoscopic treatment of ureteral calculi. A review of 378 cases. Eur Urol. 1999;36(1):48–52.PubMedCrossRefGoogle Scholar
  46. 46.
    Coptcoat MJ, Webb DR, Kellet MJ, Whitfield HN, Wickham JE. The steinstrasse: a legacy of extracorporeal lithotripsy? Eur Urol. 1988;14(2):93–5.PubMedGoogle Scholar
  47. 47.
    Fedullo LM, Pollack HM, Banner MP, Amendola MA, Van Arsdalen KN. The development of steinstrassen after ESWL: frequency, natural history, and radiologic management. AJR Am J Roentgenol. 1988;151(6):1145–7.PubMedGoogle Scholar
  48. 48.
    Madbouly K, Sheir KZ, Elsobky E, Eraky I, Kenawy M. Risk factors for the formation of a steinstrasse after extracorporeal shock wave lithotripsy: a statistical model. J Urol. 2002;167(3):1239–42.PubMedCrossRefGoogle Scholar
  49. 49.
    Al-Awadi KA, Abdul Halim H, Kehinde EO, Al-Tawheed A. Steinstrasse: a comparison of incidence with and without J stenting and the effect of J stenting on subsequent management. BJU Int. 1999;84(6):618–21.PubMedCrossRefGoogle Scholar
  50. 50.
    Sulaiman MN, Buchholz NP, Clark PB. The role of ureteral stent placement in the prevention of steinstrasse. J Endourol. 1999;13(3):151–5.PubMedCrossRefGoogle Scholar
  51. 51.
    Kim SC, Oh CH, Moon YT, Kim KD. Treatment of steinstrasse with repeat extracorporeal shock wave lithotripsy: experience with piezoelectric lithotriptor. J Urol. 1991;145(3):489–91.PubMedGoogle Scholar
  52. 52.
    Beck SM, Finley DS, Deane LA. fungal urosepsis after ureteroscopy in cirrhotic patients: a word of caution. Urology. 2008;72(2):291–3.PubMedCrossRefGoogle Scholar
  53. 53.
    Wolf Jr JS, Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ. Urologic Surgery Antimicrobial Prophylaxis Best Practice Policy Panel. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008;179(4):1379–90.PubMedCrossRefGoogle Scholar
  54. 54.
    Manger JP, Mendoza PJ, Babayan RK, Wang DS. Use of renal ultrasound to detect hydronephrosis after ureteroscopy. J Endourol. 2009;23(9):1399–402.PubMedCrossRefGoogle Scholar
  55. 55.
    Adiyat KT, Meuleners R, Monga M. Selective postoperative imaging after ureteroscopy. Urology. 2009;73(3):490–3.PubMedCrossRefGoogle Scholar
  56. 56.
    Weizer AZ, Auge BK, Silverstein AD, Delvecchio FC, Brizuela RM, Dahm P, Pietrow PK, Lewis BR, Albala DM, Preminger GM. Routine postoperative imaging is important after ureteroscopic stone manipulation. J Urol. 2002;168(1):46–50.PubMedCrossRefGoogle Scholar
  57. 57.
    Bugg Jr CE, El-Galley R, Kenney PJ, Burns JR. Follow-up functional radiographic studies are not mandatory for all patients after ureteroscopy. Urology. 2002;59(5):662–7.PubMedCrossRefGoogle Scholar
  58. 58.
    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
  59. 59.
    Dretler SP, Young RH. Stone granuloma: a cause of ureteral stricture. J Urol. 1993;150(6):1800–2.PubMedGoogle Scholar
  60. 60.
    Elliott DS, Segura JW, Lightner D, Patterson DE, Blute ML. Is nephroureterectomy necessary in all cases of upper tract transitional cell carcinoma? Long-term results of conservative endourologic management of upper tract transitional cell carcinoma in individuals with a normal contralateral kidney. Urology. 2001;58(2):174–8.PubMedCrossRefGoogle Scholar
  61. 61.
    Martinez-Pineiro JA, Garcia Matres MJ, Martinez-Pineiro L. Endourological treatment of upper tract urothelial carcinomas: analysis of a series of 59 tumors. J Urol. 1996;156(2 Pt 1):377–85.PubMedCrossRefGoogle Scholar
  62. 62.
    Elliott DS, Blute ML, Patterson DE, Bergstralh EJ, Segura JW. Long-term follow-up of endoscopically treated upper urinary tract transitional cell carcinoma. Urology. 1996;47(6):819–25.PubMedCrossRefGoogle Scholar
  63. 63.
    Chen GL, Bagley DH. Ureteroscopic management of upper tract transitional cell carcinoma in patients with normal contralateral kidneys. J Urol. 2000;164(4):1173–6.PubMedCrossRefGoogle Scholar
  64. 64.
    Keeley Jr FX, Bibbo M, Bagley DH. Ureteroscopic treatment and surveillance of upper urinary tract ­transitional cell carcinoma. J Urol. 1997;157(5):1560–5.PubMedCrossRefGoogle Scholar
  65. 65.
    Delvecchio FC, Auge BK, Brizuela RM, Weizer AZ, Silverstein AD, Lallas CD, Pietrow PK, Albala DM, Preminger GM. Assessment of stricture formation with the ureteral access sheath. Urology. 2003;61(3):518–22.PubMedCrossRefGoogle Scholar
  66. 66.
    Ayyathurai R, Kanagarajah P, Shields J, Young E, Alvarez A, Bird VG. Single-center clinical comparison of two reinforced ureteral access sheaths for retrograde ureteroscopic treatment of urinary lithiasis. Int Urol Nephrol. 2012;44(2):409–14.PubMedCrossRefGoogle Scholar
  67. 67.
    Elliott SP, McAninch JW. Ureteral injuries: external and iatrogenic. Urol Clin North Am. 2006;33(1):55–66.PubMedCrossRefGoogle Scholar
  68. 68.
    Perez-Brayfield MR, Keane TE, Krishnan A, Lafontaine P, Feliciano DV, Clarke HS. Gunshot wounds to the ureter: a 40-year experience at Grady Memorial Hospital. J Urol. 2001;166(1):119–21.PubMedCrossRefGoogle Scholar
  69. 69.
    Ghali AM, El Malik EM, Ibrahim AI, Ismail G, Rashid M. Ureteric injuries: diagnosis, management, and outcome. J Trauma. 1999;46(1):150–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • David A. Leavitt
    • 1
  • J. Kyle Anderson
    • 1
    Email author
  • Sean P. Elliott
    • 1
  1. 1.Department of UrologyUniversity of MinnesotaMinneapolisUSA

Personalised recommendations