Abstract
Purpose
Advancements in the endourological equipment have made retrograde intrarenal surgery (RIRS) an attractive, widespread technique, capable of competing with traditional shock wave lithotripsy and percutaneous nephrolithotomy. Since the complication rate is generally low, even less is known about dramatic and fatal complications after RIRS.
Methods
We performed a survey asking 11 experienced endourologists to review their RIRS series and report the cases of mortality to their best knowledge.
Results
Six urologists reported on six fatal cases. In three cases, a history of urinary tract infections was present. Four patients died from urosepsis, one due to an anesthetic and one due to hemorrhagic complication. The use of ureteral access sheath was not common.
Conclusion
Even respecting the standards of care, it may happen that physicians are occasionally tempted to overdo for their patients, sometimes skipping safety rules with an inevitable increase in risks. Despite the fact that RIRS has become a viable option for the treatment of the majority of kidney stones, its complication rates remain low. Nevertheless, rare fatal events may occur, especially in complex cases with a history of urinary tract infections, and advanced neurological diseases.
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References
Giusti G, Proietti S, Peschechera R et al (2015) Sky is no limit for ureteroscopy: extending the indications and special circumstances. World J Urol 33(2):257–273
Fall B, Mouracade P, Bergerat S, Saussine C (2014) Flexible ureteroscopy and laser lithotripsy for kidney and ureter stone: indications, morbidity and outcome. Prog Urol 24(12):771–776
Robert M, Drianno N, Marotta J, Delbos O, Guiter J, Grasset D (1997) The value of retrograde ureterorenoscopy in the treatment of bulky kidney calculi. Prog Urol 7(1):35–41
Watson JM, Chang C, Pattaras JG, Ogan K (2011) Same session bilateral ureteroscopy is safe and efficacious. J Urol 185(1):170–174
Türk C, Knoll T, Petrik A et al (2015) Guidelines on urolithiasis. European Association Guidelines. http://www.uroweb.org/gls/pdf/22%20Urolithiasis_LR.pdf. last Access on 15 Jan 2015
Jung H, Nørby B, Frimodt-Møller PC, Osther PJ (2008) Endoluminal isoproterenol irrigation decreases renal pelvic pressure during flexible ureterorenoscopy: a clinical randomized, controlled study. Eur Urol 54(6):1404–1413
McAleer IM, Kaplan GW, Bradley JS, Carroll SF, Griffith DP (2003) Endotoxin content in renal calculi. J Urol 169(5):1813–1814
Stern JM, Yiee J, Park S (2007) Safety and efficacy of ureteral access sheaths. J Endourol 21:119–123
Salluh JI, Nobre V, Povoa P (2014) Using procalcitonin to guide antimicrobial duration in sepsis: asking the same questions will not bring different answers. Crit Care 18(3):142–144
Zheng J, Li Q, Fu W et al (2015) Procalcitonin as an early diagnostic and monitoring tool in urosepsis following percutaneous nephrolithotomy. Urolithiasis 43(1):41–47
Pearle M (2015) My approach to using prophylactic antibiotics in patients undergoing ureteroscopic stone removal with a negative baseline urine culture. Published in urology expert opinion. http://www.practiceupdate.com/content/my-approach-to-using-prophylactic-antibiotics-in-patients-undergoing-ureteroscopic-stone-removal-with-a-negative-baseline-urine-culture/23311
Acknowledgments
The authors thank Kimberlee Ann Manzi for professionally reviewing the linguistic style of the manuscript.
Author’s contribution
Dr. Cindolo, Castellan, Giusti, Scoffone organised the project and developed the protocol. Dr. Cindolo, Cracco, Paccaduscio, Breda, Celia, Proietti did the data collection. The analysis of he data was done by Dr. Castellan, Cindolo, Cracco. Castellan, Schips, Giusti wrote and edited the manuscript . Dr. Scoffone, Giusti, Breda, Schips supervised the process.
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Guido Giusti is a consultant for Boston Scientific, Cook Medical, Porges-Coloplast, Karl Storz. Cesare Mario Scoffone is a consultant for Boston Scientific, Cook Medical, Porges-Coloplast, Karl Storz. Alberto Breda is a consultant for Cook Medical, Rocamed, Karl Storz.
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Informed consent was obtained from all individual participants included in the study.
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Cindolo, L., Castellan, P., Scoffone, C.M. et al. Mortality and flexible ureteroscopy: analysis of six cases. World J Urol 34, 305–310 (2016). https://doi.org/10.1007/s00345-015-1642-0
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DOI: https://doi.org/10.1007/s00345-015-1642-0