title: Ureteroscopy in patients with coagulopathies is associated with lower stone-free rate and increased risk of clinically significant hematuria.
abstract: OBJECTIVE
  Patients with coagulopathy are at increased risk of peri-operative hemorrhage. The aim of the present study was to compare ureteroscopy (URS) in these high risk patients to those with normal bleeding profile.
  
  
  METHODS
  Twelve patients with coagulopathies (Group I) undergoing 17 URS were included in the study [3 for biopsy of ureteral lesions and 9 for Holmium Laser Lithotripsy (HLL)]. A patient had Child B (MELD 11) cirrhosis, 6 patients were on warfarin, 3 patients on ASA, 1 patient on ASA and clopidogrel, and the last patient was on heparin. URS in Group I was performed without correction of coagulopathy. Group II consisted of 32 patients with normal bleeding profile who underwent 34 URS concurrently.
  
  
  RESULTS
  Group I included 4 ureteral biopsies in 3 patients with suspicious ureteral lesions and 13 URS for HLL in 9 patients with nephrolithiasis. There were no significant differences between the two groups in terms of patient age, sex, percent of renal stones, median operative and fluoroscopy times. When compared with Group II, Group I had significantly larger median stone size (9.2 vs. 14.0 mm, p = 0.01) and significantly lower stone-free rate after fi rst URS (94.1% vs. 69.2%, p=0.04). However, after second URS, stone-free rates were comparable in both groups (92.3% vs. 100 %, p = 0.9). Two (16.7%) patients with coagulopathy were readmitted due to gross hematuria. There were no post-operative complications in Group II.
  
  
  CONCLUSIONS
  Although URS in selected patients with coagulopathies is safe, it is associated with significantly lower stone-free rates and higher readmissions due to gross hematuria.
authors.affiliation: Department of Surgery, Division of Urology, McGill University Health Center, McGill University, Montreal Quebec, Canada.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elkoushy
authors.forename: Philipe D
authors.initials: PD
authors.lastname: Violette
authors.forename: Sero
authors.initials: S
authors.lastname: Andonian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001778:Blood Coagulation Disorders / Q000150:complications*; D016022:Case-Control Studies; D005260:Female; D006417:Hematuria / Q000209:etiology*; D006801:Humans; D007669:Kidney Calculi / Q000473:pathology / Q000601:surgery*; D017602:Lithotripsy, Laser / Q000379:methods*; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D012189:Retrospective Studies; D012306:Risk; D014513:Ureter / Q000293:injuries; D018666:Ureteroscopy / Q000009:adverse effects*