Life-threatening complications after ureteroscopy for urinary stones: survey and systematic literature review.
BACKGROUND
Retrograde ureteroscopy (URS) has become a common procedure for the management of urinary stones. Although its efficacy and safety are well known, the literature about major complications is still poor. This study highlighted some cases of life-threatening complications after semi-rigid ureteroscopy (s-URS) or flexible ureteroscopy (f-URS).


METHODS
Experienced endourologists (more than 75 cases/year in the last 3 years) we enrolled, and a survey was performed asking to review their series and report the cases encumbered by major complications (Clavien-Dindo IIIb-IV grade). A literature search was also conducted in the Medline (PubMed) and Cochrane Libraries databases in July, 2016 to identify all studies reporting the presence of major complications in patients underwent URS procedures. A PubMed search was performed using the following key words in combination: "kidney injury," "ureteroscopy," "nephrectomy," "life-threatening," "urinary stones," "complications."


RESULTS
Eleven urologists reported on 12 major complications (4 after s-URS, 8 after f-URS). Eight patients developed a kidney injury, 1 an arteriovenous fistula, 2 a ureter avulsion and 1 acute sepsis. Six patients underwent open nephrectomy, two surgical repair, one open pyeloplasty, one coil artery embolization and two superselective artery embolization.


CONCLUSIONS
Guidelines and clinical practice give useful recommendations about intraoperative safety and prevention of life-threatening events. The careful postoperative observation and the surgical active treatment of this complications play a key role in reducing morbidity, kidney loss and mortality. This study encourages a strict and active care of patients, supports a routine reporting of complications, and highlights the need for systematic use of standardized classification systems.
Department of Urology, ASL2 Abruzzo, Chieti, Italy.
Luca
L
Cindolo
Department of Urology, ASL2 Abruzzo, Chieti, Italy - castellanpietro@gmail.com.
Pietro
P
Castellan
Department of Urology, G. D'Annunzio University, Chieti, Italy.
Giulia
G
Primiceri
Department of Urology, Henri Mondor Hospital, Créteil, France.
Andras
A
Hoznek
Department of Urology, Cottolengo Hospital, Turin, Italy.
Cecilia M
CM
Cracco
Department of Urology, Cottolengo Hospital, Turin, Italy.
Cesare M
CM
Scoffone
Department of Urology, Niguarda Ca' Granda Hospital, Milan, Italy.
Antonio
A
Galfano
Department of Urology, Niguarda Ca' Granda Hospital, Milan, Italy.
Giovanni
G
Petralia
Department of Urology, San Donato Hospital, Arezzo, Italy.
Michele
M
DE Angelis
Department of Urology, San Donato Hospital, Arezzo, Italy.
Filippo
F
Annino
Department of Urology, Umberto I Hospital, Enna, Italy.
Emilio
E
Malacasa
Department of Urology, Ospedali Riuniti, Foggia, Italy.
Luigi
L
Cormio
Department of Urology, Ca' Granda and Maggiore Polyclinic Hospital, Foundation, and Institute for Research and Care, Milan, Italy.
Pietro
P
Acquati
Department of Urology, Ca' Granda and Maggiore Polyclinic Hospital, Foundation, and Institute for Research and Care, Milan, Italy.
Elisa
E
DE Lorenzis
Department of Urology, Santa Croce Hospital, Cuneo, Italy.
Orazio
O
Maugeri
Department of Urology, Santa Croce Hospital, Cuneo, Italy.
Giuseppe
G
Arena
Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy.
Antonio
A
Celia
Department of Urology, San Raffaele Hospital and Institute for Research and Care, Milan, Italy.
Guido
G
Giusti
Department of Urology, ASL2 Abruzzo, Chieti, Italy.
Luigi
L
Schips
D005260:Female; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires; D018666:Ureteroscopy / Q000009:adverse effects*; D014545:Urinary Calculi / Q000150:complications* / Q000000981:diagnostic imaging*; D000072178:Urologists