Factorii predictivi ai complicaţiilor în ureteroscopia retrogradă rigidă şi semirigidă

Abstract

Background. Currently, ureteroscopy is a worldwide procedure with varied number of diagnostic and therapeutic possibilities, including treatment of stones, upper urinary tract tumors, strictures, placement of difficult ureteral stents, and diagnosis of filling defects or haematuria of unknown origin. However, the technique has complications including bleeding, fever and sepsis, ureteral perforation, false passage, urinoma, strictures and, rarely, ureteral avulsion. PURPOSE. Our purpose was to evaluate the ureteroscopies with long hospitalization and to analyse the preoperative predictive factors for the complications. METHODS. We retrospectively reviewed all 342 files of the patients who underwent retrograde ureteroscopy for different reasons between january 2005 and december 2009. Data were abstracted on period of hospitalization, indications for the procedure (urolithiasis – site, number and size, reno-ureteral haematuria, filling defects), bioumoral status, outcome and complications of the method. RESULTS. The mean hospitalization time was 6,53 ± 2,09 days, with a preoperative period of 3,37 ± 1,74 days and a postoperatory time of 2,16 ± 1,08 days. Only 40 patients (11,7%) have exceled this postoperatory period due to a complicated outcome, meanwhile the preoperative time was tidely corelated with the diagnostic imaging methods. The success rate of all therapeutic procedures was 84,74% and the overall and major complication rates was 23,09% and 4,97%. The analysis of preoperative factors showed that preoperative bacteriuria is statistically correlated with postoperatory complications, such as fever and sepsis (p<0.001), and persistent haematuria is linked to stone size and ureteral stent size placed at the end of the procedure (8Ch) without having statistical significance. CONCLUSIONS. Our experience suggests that carefully performed retrograde ureteroscopy is a superb tool for the urologist, either for diagnostic or therapeutic purposes. However, when performing an ureteroscopy, one should always bear in mind the possibility of serious complications, including ureteral avulsion or perforation.