An audit of 2273 ureteroscopies - a focus on a intra-operative complications to justify proactive management of ureteric calculi

Background: At the National Stone Centre we have adopted a proactive management approach involving early ureteroscopy for ureteric calculi. As the efficacy of ureteroscopy is known this study focuses on the low intra-operative complication rate as justification for a proactive management protocol. Patients and Methods: A retrospective study (1987-1997) identified 1,936 patients undergoing 2,273 ureteroscopies. A database was created from inpatient hospital records. The male to female ratio was 3 to 1, age range was 25 to 84 years. Results: Twenty-three patients (1%) had an intra-operative complication during ureteroscopy. Immediate ureteric JJ stenting was performed in 16 cases with ureteric injury. Two cases underwent percutaneous drainage and delayed antegrade ureteric stenting, ureteroscopy was terminated because of poor visibility. Five patients (0.22%) underwent open surgery for: ureteric perforation (n=2); Dormia basket ureteric avulsion (n=1); impacted Dormia basket and stone (n=1); and impacted balloon dilator and stone (n=1). Ureteroscopic complications were not related to the level of ureteric calculus. Conclusion: A protocol of proactive management of ureteric calculi facilitates rapid turnover of large patient numbers. This approach is supported by the low intra-operative complication rate, most of which can be managed by further endoscopic procedures. In the event of corrective open surgery a favourable outcome has resulted.