title: Rigid ureteroscopy for ureteral stones: factors associated with intraoperative adverse events.
abstract: OBJECTIVE
  To analyze some of the factors that may be associated with a higher incidence of complications during management of ureteral stones by rigid ureteroscopy.
  
  
  METHODS
  We reviewed all ureteroscopic interventions aimed at stone extraction and/or fragmentation in our institution from 2001 through 2005. A total of 442 interventions were eligible for inclusion. Our focus was concentrated on (1) patient characteristics (age, gender, duration of symptoms, history of urinary schistosomiasis, and history of surgery involving the affected ureter), (2) stone characteristics (number, length, width, and level of the ureter affected), (3) the affected reno-ureteral unit (which side was affected, the kidney's ability to excrete contrast medium, and the status of the ureter proximal and distal to the stone), and finally (4) experience level of the surgeon in charge (junior v senior). The occurrence of intraoperative adverse events was considered a dependent variable and was statistically related to each of the above factors as independent variables.
  
  
  RESULTS
  Intraoperative adverse events were encountered in 121 interventions including stone migration in 54, minor mucosal injuries in 24, ureteral perforation in 12, ureteral avulsion in 2, and aborted procedure due to bleeding or edema in 29. Symptomatology present for more than 3 months, a negative history of schistosomiasis, a positive history of ureteral surgery, stones above the ischial spines, stones >5 mm in width, a dilated proximal ureter, kidneys that failed to excrete contrast medium, and involvement of a more junior urologist were factors that were associated with a statistically significantly higher incidence of intraoperative complications.
  
  
  CONCLUSIONS
  Rigid ureteroscopic stone manipulation remains a procedure that should be handled cautiously. Existence of any of the above risk factors should alert urologists, particularly at training centers, to adopt all possible precautionary measures.
authors.affiliation: Department of Urology, Al-Azhar University, Cairo, Egypt. yahmedfahim@hotmail.com
authors.forename: Ahmed F
authors.initials: AF
authors.lastname: Abdelrahim
authors.forename: Abulfotouh
authors.initials: A
authors.lastname: Abdelmaguid
authors.forename: Hamdi
authors.initials: H
authors.lastname: Abuzeid
authors.forename: Moamen
authors.initials: M
authors.lastname: Amin
authors.forename: El-Sayed
authors.initials: el-S
authors.lastname: Mousa
authors.forename: Fahim
authors.initials: F
authors.lastname: Abdelrahim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography; D014514:Ureteral Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D020709:Ureteroscopes / Q000009:adverse effects*; D018666:Ureteroscopy / Q000009:adverse effects / Q000379:methods*; D014567:Urography