The fate of the iatrogenic retroperitoneal stone

Ureteral perforation with resultant retroperitoneal stone expulsion is a recognized complication of ureteroscopy. In a 5-year retrospective review of 400 cases we identified a 1.3% incidence of iatrogenic retroperitoneal stone dislodgment. Average followup was 21 months. Four cases were managed with observation and 1 required surgical correction of a ureteropelvic junction stricture. We discuss the management of this problem, which begins with thorough radiographic documentation in the perioperative period. Aggressive ureteroscopic manipulation and attempted stone retrieval are not warranted, and a ureteral stent should be placed. Radiographic followup and clinical observation confirm the low morbidity associated with retroperitoneal urinary stones. Patient understanding of the extra-ureteral stone location is essential to avoid misdiagnosis and mismanagement by uninformed physicians in the future.