WCE 2019: Beware of Laser, Ureteral Stenosis after Ureteroscopy

Abu Dhabi, United Arab Emirates (UroToday.com) Dr. Felipe Pauchard presented on identifying silent obstructions after ureteroscopy and possible predictors. Previously identified risk factors include perforation and stone impaction. The importance of identifying silent obstruction is to prevent renal failure. They retrospectively evaluated patients who underwent semi-rigid ureteroscopy from January 2014 to April 2019. Clinical parameters were recorded. If dilation was noted on ultrasound, a follow-up CT scan was performed. They evaluated 118 patients. 31 patients were excluded (3 were deceased at the time of contact, 28 could not be contacted). Of the 87 patients in the study, 52% female and 48% males. The age median was 53 years (42.5-59.5). Distal ureteral stones were found in 75% of patients. Stone free rate was 95%. Median follow up was 24 (12.5-36.8) months. 4 patients developed silent stenosis. Of the patients with silent stenosis, 2 involved the mid and 2 involved the proximal ureter. None involved the distal ureter. Two patients already had renal atrophy. All 4 patients underwent laser lithotripsy. The average stone size was 11.8mm. All 4 patients had a ureteral stent placed. 2 of the 4 patients had impacted stones. While not reported in the data, the authors noted that Traxer’s classification of ureteral damage did not correlate with clinical silent obstruction.

They concluded that the risk of stricture formation after ureteroscopy is not well assessed. Ultimately, they contended the need for follow-up ultrasound after ureteroscopy, which is already implemented in a number of guidelines.

Presented by: Felipe Pauchardat, MD, Servicio Urologia Hospital Carlos Van Buren. Universidad de Valparaiso, Valparaiso, Chile

Written by: Pengbo Jiang, MD Department of Urology, University of California, Irvine, at the 37th World Congress of Endourology (WCE) – October 29th-November 2nd, Abu Dhabi, United Arab Emirates