title: Mortality and flexible ureteroscopy: analysis of six cases.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, "S. Pio da Pietrelcina" Hospital, Via San Camillo de Lellis 1, 66054, Vasto, Italy. lucacindolo@virgilio.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
authors.affiliation: Department of Urology, "SS. Annunziata" Hospital, Chieti, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Castellan
authors.affiliation: Department of Urology, "Cottolengo" Hospital, Turin, Italy.
authors.forename: Cesare Marco
authors.initials: CM
authors.lastname: Scoffone
authors.affiliation: Department of Urology, "Cottolengo" Hospital, Turin, Italy.
authors.forename: Cecilia Maria
authors.initials: CM
authors.lastname: Cracco
authors.affiliation: Department of Urology, "San Bassiano" Hospital, Bassano del Grappa, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Celia
authors.affiliation: Department of Urology, Legnano Hospital, Legnano, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Paccaduscio
authors.affiliation: Department of Urology, "S. Pio da Pietrelcina" Hospital, Via San Camillo de Lellis 1, 66054, Vasto, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Schips
authors.affiliation: Stone Center at Department of Urology, "Humanitas Clinical and Research Center", Rozzano, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Proietti
authors.affiliation: Department of Urology, "Universidad Autonoma de Barcelona, Fundaciò Puigvert", Barcelona, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Breda
authors.affiliation: Stone Center at Department of Urology, "Humanitas Clinical and Research Center", Rozzano, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Giusti
mesh_terms: D000328:Adult; D000368:Aged; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007669:Kidney Calculi / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D018666:Ureteroscopy / Q000401:mortality*
keywords: Complications; Death; Flexible ureteroscopy; Laser lithotripsy; Renal stone; Retrograde intrarenal surgery