Complications of Ureteroscopy

Ureteroscopy is used with increasing regularity to diagnose and treat myriad upper urinary tract pathologies. Advances and miniaturization in the design of ureteroscopes and their accessory instruments combined with sound ureteroscopic technique make modern ureteroscopy quite safe. However, complications of ureteroscopy still do occur and can result in severe ureteral injury and possible kidney loss. There exists no standardized classification system to report complications of ureteroscopy and so determining exact incidences of these complications is difficult. The vast majority of complications is minor and usually requires little more than ureteral stenting and time. Major ureteroscopic misadventures are considered those that are life threatening or require further open or laparoscopic surgical repair. Overall major complications of ureteroscopy happen infrequently and the incidence appears to be decreasing. Major ureteral injuries are usually recognized during ureteroscopy and allow for prompt management. The preferred approach to the repair of major ureteral injuries depends on the nature of the injury and its length and location. Proper technique and familiarity with the various ureteroscopes and accessories is important to minimizing the complications of ureteroscopy. A thorough understanding of the different possible complications and predisposing risk factors can help to anticipate and avoid these complications. Appropriate and timely management of complications when they do arise is a crucial step to safe and successful ureteroscopy.