Intraoperative incidents and complications

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Intraoperative incidents and complications after semirigid ureteroscopies – Single center experience on 10,001 cases Prof. Petrisor GEAVLETE, MD, PhD. Razvan Multescu, MD, PhD. Bogdan Geavlete, MD, PhD. Saint John Emergency Clinical Hospital Bucharest, Romania

Digital 10,001 procedures – 9,124 patients Improved visibility 7.5F 8/9.8F Wolf, 8 and 10F Storz, 8.5/9.9 F Olympus Endoeye digital semirigid ureteroscopes Balistic, electrohydaulic or Ho:YAG laser lithotripters. Improved visibility Digital P.Geavlete, 2008 P.Geavlete, 2008 P.Geavlete, 2008 P.Geavlete, 2008 P.Geavlete, 2008

Intraoperative incidents (4.3%) failure to negotiate de ureteral orifice (68 cases) failure to reach the calculi (237 cases) fixed stone baskets (69 cases) equipment damages (40 cases) double J stent malpositioning (12 cases) All the incidents were dealt endoscopically, except one case of fixed basket that imposed open extraction.

Intraoperative complications (2.8%) lesions of the ureteral mucosa (167 cases) perforation (68 cases) bleeding (26 cases) ureteral avulsion (3 cases) extra-ureteral stone migration (12 cases) All intraoperative complications were identified intraoperatively and treated immediately Open surgery was necessary in only 5 cases.

Lesions of the ureteral mucosa Perforation Fixed stone baskets P.Geavlete, 2000 P.Geavlete, 2009 P.Geavlete, 2007

Conclusions Due to technological advances and increased experience, the semirigid retrograde ureteroscopic treatment of ureteral lithiasis increased the efficacy, while the incidence of intraoperative complications decreased. Most of these complications are minor and can be managed by conservative approach.