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Complications of pneumatic ureterolithotripsy in the early postoperative period
I Atilla Aridogan1, Sinan Zeren, Yildirim Bayazit
1Department of Urology, Faculty of Medicine, University of Cukurova, Adana, Turkey. aridogan@cu.edu.tr
Insights
Pneumatic ureterolithotripsy effectively removes kidney stones with a low complication rate. This minimally invasive procedure offers high patient tolerance and short hospital stays for effective stone management.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Nephrolithiasis Treatment
Background:
- Ureterolithiasis is a common condition requiring effective treatment.
- Minimally invasive techniques are preferred for stone removal.
Purpose of the Study:
- To document perioperative and early postoperative complications of pneumatic ureterolithotripsy.
- To evaluate the safety and efficacy of pneumatic ureterolithotripsy.
Main Methods:
- A prospective study involving 979 patients (665 male, 314 female) with ureteral stones >0.5 cm.
- Pneumatic ureterolithotripsy performed using rigid ureteroscopes and the Vibrolith pneumatic lithotripter.
- Standard preoperative and postoperative evaluations including imaging and urinalysis.
Main Results:
- Complete stone removal in 86.5% of patients, with 80% discharged on the same day.
- Perioperative complications included stone migration (7.2%), mucosal damage (3.5%), and ureteral perforation (1.7%).
- Early postoperative issues comprised flank pain (18.4%), hematuria (7.3%), and urinary tract infection (5%).
Conclusions:
- Pneumatic ureterolithotripsy is a safe and effective minimally invasive procedure for ureteral stones.
- The technique is associated with a low complication rate and facilitates short hospital stays.
- Meticulous technique and appropriate instrumentation are key to successful outcomes.
Purpose:
To document the perioperative and early postoperative complications of pneumatic ureterolithotripsy.
Patients And Methods:
Between January 1997 and December 2003, pneumatic ureterolithotripsy was performed in 665 male and 314 female patients for stones >0.5 cm. The age range was 9 months to 72 years (mean 41 years). Preoperatively, intravenous urography, urinalysis, and urine culture were done. Cefepime 1 g was given as prophylactic antimicrobial therapy 1 hour prior to surgery. A plain film of the urinary tract was taken immediately before the procedure. The operations were carried out with the patient under general anesthesia. Rigid ureteroscopes (6.9F ACMI "micro-6" or 8F-10F Storz) and the Vibrolith (Elmed, Ankara, Turkey) pneumatic lithotripter were used. The fragments were extracted with forceps or baskets. Urinalysis and culture as a routine postoperative evaluation and a plain film or ultrasonogram of the urinary tract when needed were done 1 week after the procedure.
Results:
The stones were completely removed in 847 patients (86.5%); 783 (80%) of them went home on the day of surgery. A ureteral stent was needed in 401 patients (41.0%). Perioperative complications were migration of the stone into the kidney in 70 patients (7.2%), mucosal damage in 34 (3.5%), ureteral perforation in 17 (1.7%), ureteral avulsion in 4 (0.4%), and conversion to open surgery in 3 (0.2%). During the early postoperative period, flank pain (18.4%), pelvic discomfort (5.5%), macroscopic hematuria (7.3%), and urinary tract infection (5%) were recorded.
Conclusion:
Ureterolithotripsy by a pneumatic lithotripter is a minimally invasive, highly tolerable procedure with a low complication rate and short hospital stay when performed meticulously with appropriate instruments.
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