Boyko A. I., Polovynka V. P.

COMPLICATIONS OF CONTACT LASER URETEROLITHOTRIPSY OF STONES IN THE UPPER THIRD OF THE URETER

---

Show/Download

About the author:

Boyko A. I., Polovynka V. P.

Heading:

CLINICAL AND EXPERIMENTAL MEDICINE

Type of article:

Scientific article

Annotation:

Contact ureterolithotripsy (CULT) is one of the main methods for the treatment of stones in the upper third of the ureter. At the same time, the performance of this intervention is associated with a risk of intra- and postoper ative complications, the probability of which depends on the size of the calculus, the duration of obstruction, and the infectious status of the urinary tract. Quantitative assessment of these factors is important for risk stratification and improving treatment safety. The aim of the study was to analyze the frequency and structure of intra- and post operative complications during CULT of stones in the upper third of the ureter, as well as to determine the influence of stone size, duration of its presence in the ureter, and urinary bacterial load on the risk of their development. A retrospective analysis of 282 consecutive cases of CULT was performed, with complications classified according to the Clavien–Dindo scale. Methods of descriptive statistics, comparison of proportions, and binary logistic regression were used for statistical analysis. Intraoperative complications were observed in 10.3% of cases, mainly in the form of micro- or macroperforations and injuries to the mucous membrane. Postoperative complications were noted in 9.6% of patients, among which late ureteral strictures accounted for 1.8%. It was established that an increase in stone size is associated with a higher frequency of intraoperative events, whereas higher bacteriuria is associated with a greater likelihood of postoperative complications. The obtained results indicate that CULT for stones of the upper third of the ureter has an acceptable safety profile provided that atraumatic technique, adequate drainage, and sanitation of the urinary tract are ensured. Consideration of calculus size, duration of obstruction, and bacteri uria during preoperative risk stratification contributes to the optimization of treatment strategy and reduction in the incidence of complications.

Tags:

Bibliography:

1. De Coninck V, Keller EX, Somani BK, Giusti G, Proietti S, Rodriguez-Socarras M, et al. Complications of ureteroscopy: a complete overview. World J Urol. 2020;38(9):2147-66. DOI: 10.1007/s00345-019-03012-1.
2. Chuang TY, Kuo HC, Li CC, Wang CJ, Tsai CH, Chou YH, et al. Risk factors of morbidity and mortality after flexible ureteroscopic lithotripsy. Urol Sci. 2020;31(6):253-7. DOI: 10.4103/UROS.UROS_85_20.
3. Nasser H, Yousef M, Alshamali A. Complications of ureteroscopy: a study in Tishreen University Hospital (1/8/2020–1/8/2021). Tishreen Univ J Res Health Sci. 2022;44(1):221-33.
4. Dupuis H, Khene ZE, Surlemont L, Saout K, Bakayoko A, Ducousso H, et al. Preoperative risk factors for complications after flexible and rigid ureteroscopy for stone disease: A French multicentric study. Prog Urol. 2022;32(8-9):593-600. DOI: 10.1016/j.purol.2022.02.009.
5. Guo T, Zhang J, Gao W, Ma Y. Analysis of risk factors for urinary tract infection and bleeding after retrograde flexible ureteroscopy for stone removal. Front Surg. 2025;12:1573485. DOI: 10.3389/fsurg.2025.1573485.
6. Dai L, Xiang J, Liu X, Wen X, Tan L, Zhang J. Risk factors for urosepsis following ureteroscopic lithotripsy: a systematic review and meta analysis. Front Surg. 2025;12:1603311. DOI: 10.3389/fsurg.2025.1603311.
7. Çakıcı MÇ, Kazan Ö, Çiçek M, İplikçi A, Yıldırım A, Atış G. Predictive risk factors of urinary tract infection following flexible ureteroscopic lithotripsy. Arch Esp Urol. 2021;74(5):503-10.
8. Yao F, Jiang X, Xie B, Liu N. Comparison of ureteroscopy complementary treatment after extracorporeal shock wave lithotripsy failure with primary ureteroscopy lithotripsy with holmium laser for proximal ureteral stones larger than 10 mm. BMC Urol. 2021;21(1):126. DOI: 10.1186/s12894-021-00892-7.
9. Grosso AA, Sessa F, Campi R, Viola L, Polverino P, Crisci A, et al. Intraoperative and postoperative surgical complications after ureteroscopy, retrograde intrarenal surgery, and percutaneous nephrolithotomy: a systematic review. Minerva Urol Nephrol. 2021;73(3):309-32. DOI: 10.23736/S2724-6051.21.04294-4.
10. Ma YC, Jian ZY, Yuan C, Li H, Wang KJ. Risk Factors of Infectious Complications after Ureteroscopy: A Systematic Review and Meta Analysis Based on Adjusted Effect Estimate. Surg Infect (Larchmt). 2020;21(10):811-22. DOI: 10.1089/sur.2020.013.
11. Jarry É, Garot M, Marlière F, Fantoni JC, Villers A, Lebuffe G, et al. Predictive factors of postoperative septic complications after flexible ureteroscopy for urinary stones. Prog Urol. 2022;32(2):85-91. DOI: 10.1016/j.purol.2021.07.010.
12. Chugh S, Pietropaolo A, Montanari E, Sarica K, Somani BK. Predictors of Urinary Infections and Urosepsis After Ureteroscopy for Stone Disease: a Systematic Review from EAU Section of Urolithiasis (EULIS). Curr Urol Rep. 2020;21(4):16. DOI: 10.1007/s11934-020-0969-2.
13. Sun J, Xu J, OuYang J. Risk Factors of Infectious Complications following Ureteroscopy: A Systematic Review and Meta-Analysis. Urol Int. 2020;104(1-2):113-24. DOI: 10.1159/000504326.
14. Southern JB, Higgins AM, Young AJ, Kost KA, Schreiter BR, Clifton M, et al. Risk Factors for Postoperative Fever and Systemic Inflammatory Response Syndrome After Ureteroscopy for Stone Disease. J Endourol. 2019;33(7):516-22. DOI: 10.1089/end.2018.0789.

Publication of the article:

«Bulletin of problems biology and medicine», 2026 Issue 1, 180, 191-203 pages, index UDC 616.62–003.7–089.87–036.8

DOI:

10.29254/2077-4214-2026-1-180-191-203