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Risks of flexible ureterorenoscopy: pathophysiology and prevention

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Abstract

Currently, indications for flexible ureterorenoscopy (fURS) are expanding, mainly due to technological advancements. Although data from clinical series definitely presents fURS as a safe procedure, serious complications including sepsis and ureteral lesions do occur. These complications seem to be a result of the unique elements of fURS, ureteral access and irrigation, pushing normal upper urinary tract physiology into pathophysiological processes, including intrarenal/pyelo-veneous backflow and ureteral contractions, potentially resulting in septic, haemorrhagic and ureteral lesional complications. Knowledge on normal upper urinary tract physiology are crucial for understanding how these harmful effects of fURS may be avoided or minimized. The pathophysiology of intrarenal pressure increases and ureteral access will be discussed as a basis for understanding preventive measures. Role of antibiotics, ureteral access sheaths, safty guidewires, pain medication, prestenting and pharmacologic modulation of pyeloureteral dynamics are reviewed from a pathophysiological perspective.

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Fig. 1

Modified from Feeney et al. [7]

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Authors and Affiliations

  1. Urological Research Center, Department of Urology, Lillebaelt Hospital, Beridderbakken 4, 7100, Vejle, Denmark

    Palle J. S. Osther

  2. Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Vejle, Denmark

    Palle J. S. Osther

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Correspondence to Palle J. S. Osther.

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Palle Jörn Sloth Osther has received speaker honoraria from Olympus, Karl Storz Endoscope, Coloplast, Boston Scientific, Cook Medical and Storz Medical.

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Department of Urology, Lillebaelt Hospital, Vejle, Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark, and Japanese-Swedish Research Foundation supported the work.

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This paper is a review article. Some of the papers reviewed are based from the author’s institution. In these articles (1) all applicable international, national, and institutional guidelines for the care and use of animals were followed; and (2) all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments.

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Osther, P.J.S. Risks of flexible ureterorenoscopy: pathophysiology and prevention. Urolithiasis 46, 59–67 (2018). https://doi.org/10.1007/s00240-017-1018-6

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