Complications in emergency ureteroscopy for ureteral stone treatment: A retrospective study

Abstract

Background: Data on complications associated with emergency ureteroscopy for ureteral stones are limited, particularly in developing countries. This study investigates factors contributing to complications in emergency ureteroscopy utilizing a pneumatic semirigid ureteroscope (URS). Materials and methods: This retrospective analysis included 266 patients with ureteral stones who underwent emergency ureteroscopy using a pneumatic semirigid URS from 2018 to 2023. We extracted comprehensive data on patient demographics, stone characteristics, intraoperative and postoperative complications, and stone-free rate (SFR) from medical records, subsequently subjected to statistical analysis. Factors linked to complications were explored through univariate and multivariate analyses. Results: The mean stone size was 9.1 ± 4.9 mm, with the majority (n = 181, 71.3%) located in the mid-ureter. The mean operative duration was 57.7 ± 7.3 minutes. The overall complication rate was 10.2%, with intraoperative complications in 16 patients (6.0%), including mucosal damage (3.4%), stone up-migration (3.0%), and one ureteral perforation (0.4%). Postoperative complications occurred in 13 patients (4.9%), primarily fever (2.6%), followed by hematuria (1.1%). Additional complications included febrile urinary tract infections (UTIs), pyelonephritis, and one mortality. The overall SFR was 85.3%, with 39 patients (14.7%) demonstrating residual stones. Significant predictive factors for complications included larger stone size (Adjusted Odds Ratio [AOR]: 1.3; 95% Confidence Interval [CI]: 1.15-1.39, p <0.0001) and proximal ureteral stones (AOR: 4.9; 95% CI: 1.31-18.23, p = 0.0182). Conclusions: Emergency ureteroscopy using a semirigid URS demonstrated favorable outcomes in treating ureteral stones, characterized by minimal complications and an acceptable SFR. Emphasizing appropriate instrument selection, surgical expertise, and technique is crucial in minimizing adverse events, particularly for large and upper ureteral stones.