Mortality and flexible ureteroscopy: analysis of six cases

Abstract

Purpose: Advancements in the endourological equipment have made retrograde intrarenal surgery (RIRS) an attractive, widespread technique, capable of competing with traditional shock wave lithotripsy and percutaneous nephrolithotomy. Since the complication rate is generally low, even less is known about dramatic and fatal complications after RIRS.

Methods: We performed a survey asking 11 experienced endourologists to review their RIRS series and report the cases of mortality to their best knowledge.

Results: Six urologists reported on six fatal cases. In three cases, a history of urinary tract infections was present. Four patients died from urosepsis, one due to an anesthetic and one due to hemorrhagic complication. The use of ureteral access sheath was not common.

Conclusion: Even respecting the standards of care, it may happen that physicians are occasionally tempted to overdo for their patients, sometimes skipping safety rules with an inevitable increase in risks. Despite the fact that RIRS has become a viable option for the treatment of the majority of kidney stones, its complication rates remain low. Nevertheless, rare fatal events may occur, especially in complex cases with a history of urinary tract infections, and advanced neurological diseases.

Keywords: Complications; Death; Flexible ureteroscopy; Laser lithotripsy; Renal stone; Retrograde intrarenal surgery.