Luca Cindolo1, Pietro Castellan2, Cesare Marco Scoffone3, Cecilia Maria Cracco3, Antonio Celia4, Andrea Paccaduscio5, Luigi Schips6, Silvia Proietti7, Alberto Breda8, Guido Giusti7. 1. Department of Urology, "S. Pio da Pietrelcina" Hospital, Via San Camillo de Lellis 1, 66054, Vasto, Italy. lucacindolo@virgilio.it. 2. Department of Urology, "SS. Annunziata" Hospital, Chieti, Italy. 3. Department of Urology, "Cottolengo" Hospital, Turin, Italy. 4. Department of Urology, "San Bassiano" Hospital, Bassano del Grappa, Italy. 5. Department of Urology, Legnano Hospital, Legnano, Italy. 6. Department of Urology, "S. Pio da Pietrelcina" Hospital, Via San Camillo de Lellis 1, 66054, Vasto, Italy. 7. Stone Center at Department of Urology, "Humanitas Clinical and Research Center", Rozzano, Italy. 8. Department of Urology, "Universidad Autonoma de Barcelona, Fundaciò Puigvert", Barcelona, Spain.
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.
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.
Authors: F Berardinelli; L Cindolo; P De Francesco; S Proietti; D Hennessey; O Dalpiaz; C M Cracco; F Pellegrini; C M Scoffone; L Schips; G Giusti Journal: Urolithiasis Date: 2016-09-16 Impact factor: 3.436
Authors: P Kallidonis; A Vagionis; T Vrettos; K Adamou; K Pagonis; P Ntasiotis; G A Callas; L Tanaseskou; A M Al Aown; E Liatsikos Journal: World J Urol Date: 2020-05-29 Impact factor: 4.226
Authors: Alberto Olivero; Lorenzo Ball; Carlotta Fontaneto; Guglielmo Mantica; Paolo Bottino; Paolo Pelosi; Carlo Terrone Journal: Curr Urol Date: 2021-04-26