An audit of 2273 ureteroscopies--a focus on intra-operative complications to justify proactive management of ureteric calculi.
BACKGROUND
At the national Stone Centre we have adopted a proactive management approach involving early ureteroscopy for ureteric calculi. As the efficacy of ureteroscopy is known this study focuses on the low intra-operative complication rate as justification for a proactive management protocol.


METHODS
A retrospective study (1987-1997) identified 1936 patients undergoing 2273 ureteroscopies. A database was created from inpatient hospital records. The male to female ratio was 3 to 1, age range was 25 to 84 years.


RESULTS
Twenty-three patients (1%) had an intra-operative complication during ureteroscopy. Immediate ureteric JJ stenting was performed in 16 cases with ureteric injury. Two cases underwent percutaneous drainage and delayed antegrade ureteric stenting, ureteroscopy was terminated because of poor visibility. Five patients (0.22%) underwent open surgery for: ureteric perforation (n = 2); Dormia basket ureteric avulsion (n = 1); impacted Dormia basket and stone (n = 1); and impacted balloon dilator and stone (n = l). Ureteroscopic complications were not related to the level of ureteric calculus.


CONCLUSIONS
A protocol of proactive management of ureteric calculi facilitates rapid turnover of large patient numbers. This approach is supported by the low intra-operative complication rate, most of which can be managed by further endoscopic procedures. In the event of corrective open surgery a favourable outcome has resulted.
Butler
M R
MR
Department of Urology, The Adelaide and Meath Hospital Dublin, incorporating The National Children's Hospital, Tallaght, Dublin 24, Ireland. richiep@eircom.net
Power
R E
RE
Thornhill
J A
JA
Ahmad
I
I
McLornan
I
I
McDermott
T
T
Grainger
R
R
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D017749:Total Quality Management; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000175:diagnosis / Q000601:surgery*; D018666:Ureteroscopy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data*