title: Iatrogenic submucosal tunnel in the ureter: a rare complication during advancement of the guide wire.
abstract: BACKGROUND
  Inserting a guide wire is a common practice during endo-urological procedures. A rare complication in patients with ureteral stones where an iatrogenic submucosal tunnel (IST) is created during endoscopic guide wire placement.
  
  
  OBJECTIVE
  Summarize data on IST.
  
  
  METHODS
  Retrospective descriptive study of patients treated from from October 2009 until January 2015.
  
  
  METHODS
  King Fahd Hospital of the University, Al-Khobar, Saudi Arabia.
  
  
  METHODS
  Patients with ureteral stones were divided to 2 groups. In group I (335 patients), the ureteral stones were removed by ureteroscopy in one stage. Group II (97 patients) had a 2-staged procedure starting with a double J-stent placement for kidney drainage followed within 3 weeks with ureteroscopic stone removal.
  
  
  METHODS
  Endoscopic visualization of ureteric submucosal tunneling by guide wire.
  
  
  RESULTS
  IST occurred in 9/432 patients with ureteral stones (2.1%). The diagnosis in group I was made during ureteroscopy by direct visualization of a vanishing guide wire at the level of the stone (6 patients). In group II, IST was suspected when renal pain was not relieved after placement of the double J-stent or if imaging by ultrasound or intravenous urography showed persistent back pressure to the obstructed kidney (3 patients). The condition was subsequently confirmed by ureteroscopy.
  
  
  CONCLUSIONS
  Forceful advancement of the guide wire in an inflamed and edematous ureteral segment impacted by a stone is probably the triggering factor for development of IST. Definitive diagnosis is possible only by direct visualization during ureteroscopy. Awareness of this potential complication is important to guard against its occurrence.
  
  
  CONCLUSIONS
  Relatively small numbers of subjects and the retrospective nature of the study.
authors.forename: Hamed
authors.initials: H
authors.lastname: El Darawany
authors.forename: Alaa
authors.initials: A
authors.lastname: Barakat
authors.forename: Maha Al
authors.initials: MA
authors.lastname: Madi
authors.forename: Reem
authors.initials: R
authors.lastname: Aldamanhori
authors.forename: Khalid
authors.initials: K
authors.lastname: Al Otaibi
authors.affiliation: Dr. Ali A. Al-Zahrani, Department of Urology,, University of Dammam,, Dammam, 31952,, Saudi Arabia, T: +966138966748.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Al-Zahrani
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012529:Saudi Arabia; D015607:Stents; D014513:Ureter / Q000293:injuries*; D014514:Ureteral Calculi / Q000601:surgery*; D014515:Ureteral Diseases / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D018666:Ureteroscopy / Q000009:adverse effects* / Q000379:methods; D055815:Young Adult