One difficulty we encountered was actually tracking down imaging on the patients. Being tertiary care centers, many patients follow-up with their home Urologist so follow-up imaging is not available. We were able to track down imaging on 56 patients and found the risk of hydronephrosis without an obstructing stone to be only 5.5%. Just one patient developed a de novo stricture. We can take comfort in knowing that the risk of long-term stricture is rare after a high-grade injury from a ureteral access sheath, but missing one silent obstruction can have substantial impact so imaging should still be obtained to follow-up these patients.
Ultimately, the take home messages is that even though high-grade injuries may look significant (and frightening!), their long-term outcomes are similar to patients without an injury when looking at ureteral stricture rate. It should be noted that pre-stented patients were excluded from our study, so injuries in ureters not passively dilated with a pre-placed stent still healed appropriately. Perhaps this will make Urologists feel more comfortable with using an access sheath and breathe a little easier if an injury like the one pictured is seen.
Written by: Karen Stern, MD, Fellow, Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH
Read the Abstract