Stone and endourology
Extracorporeal, retrograde and percutaneous treatment of urinary stones.
Cystolitholapaxy and bladder stone removal
Bladder perforation or extravasation
Instruments, energy, sharp fragments or access can breach the bladder wall, especially in a diverticulum or poorly visualised bladder.
Applies to: Transurethral cystolitholapaxy · Laser cystolithotripsy · Percutaneous cystolitholapaxy · Open cystolithotomy · Combined outlet-and-stone procedureUrethral injury or later stricture
Large instruments and repeated extraction can traumatise the urethra and lead to delayed narrowing.
Applies to: Transurethral cystolitholapaxy · Laser cystolithotripsy · Combined outlet-and-stone procedureUrinary infection or sepsis
Stones may harbour bacteria, and prolonged fragmentation or impaired drainage can disseminate infection.
Applies to: Transurethral cystolitholapaxy · Laser cystolithotripsy · Percutaneous cystolitholapaxy · Open cystolithotomy · Combined outlet-and-stone procedureBleeding or clot retention
Mucosal, tract, open wound or concurrent outlet bleeding may block postoperative drainage.
Applies to: Transurethral cystolitholapaxy · Laser cystolithotripsy · Percutaneous cystolitholapaxy · Open cystolithotomy · Combined outlet-and-stone procedureResidual fragments or stone recurrence
Incomplete evacuation or an uncorrected cause such as obstruction, foreign material or bladder dysfunction can lead to recurrent calculi.
Applies to: Transurethral cystolitholapaxy · Laser cystolithotripsy · Percutaneous cystolitholapaxy · Open cystolithotomy · Combined outlet-and-stone procedureBowel or tract injury
Suprapubic access or open dissection may injure bowel or create a persistent urinary tract or wound problem.
Applies to: Percutaneous cystolitholapaxy · Open cystolithotomyCombined-procedure fluid or bleeding burden
Adding outlet surgery increases operative duration, irrigation exposure and haemostatic burden compared with stone treatment alone.
Applies to: Combined outlet-and-stone procedureFlexible ureterorenoscopy and retrograde intrarenal surgery
Ureteric wall injury or perforation
Wires, scope passage, a sheath, basket or laser can injure the ureter and create extravasation.
Applies to: Sheathless flexible URS · Access-sheath RIRS · Dusting RIRS · Fragmentation-and-basketing RIRS · Staged RIRSAccess-sheath injury or ischaemia
A sheath that is too large or advanced against resistance can split, compress or devascularise the ureter.
Applies to: Access-sheath RIRSUrinary infection or sepsis
Bacterial burden and elevated collecting-system pressure can drive systemic infection despite a technically uncomplicated procedure.
Applies to: Sheathless flexible URS · Access-sheath RIRS · Dusting RIRS · Fragmentation-and-basketing RIRS · Staged RIRSCollecting-system or parenchymal injury
Guidewires, high pressure or energy applied near calyceal mucosa can cause bleeding, perforation or subcapsular collection.
Applies to: Sheathless flexible URS · Access-sheath RIRS · Dusting RIRS · Fragmentation-and-basketing RIRS · Staged RIRSBasket entrapment or laser-device damage
A basket can trap a fragment and the laser can damage a wire, basket or deflected scope when spatial control is lost.
Applies to: Dusting RIRS · Fragmentation-and-basketing RIRSResidual fragments or recurrent stone
Inaccessible calyces, large burden or dusting may leave fragments that grow, migrate or obstruct.
Applies to: Sheathless flexible URS · Access-sheath RIRS · Dusting RIRS · Fragmentation-and-basketing RIRS · Staged RIRSUreteric stricture
Mechanical, thermal or ischaemic injury may heal with delayed ureteric narrowing.
Applies to: Sheathless flexible URS · Access-sheath RIRS · Dusting RIRS · Fragmentation-and-basketing RIRS · Staged RIRSPercutaneous nephrolithotomy
Renal haemorrhage or vascular lesion
Access, tract dilation or nephroscopic work can injure renal vessels, causing immediate bleeding or a delayed pseudoaneurysm or arteriovenous fistula.
Applies to: Standard-tract PCNL · Miniaturised PCNL · Supine PCNL · Prone PCNL · ECIRS · Tubeless PCNLPleural injury, hydrothorax or pneumothorax
An upper-pole or supracostal tract can cross pleura or diaphragm and produce fluid or air in the chest.
Applies to: Standard-tract PCNL · Miniaturised PCNL · Supine PCNL · Prone PCNL · ECIRS · Tubeless PCNLColon or solid-organ injury
Atypical anatomy or an unsafe tract can injure bowel, spleen, liver or another adjacent structure.
Applies to: Standard-tract PCNL · Miniaturised PCNL · Supine PCNL · Prone PCNL · ECIRS · Tubeless PCNLUrinary infection or sepsis
Infected stones, bacterial urine and elevated intrarenal pressure can provoke systemic infection.
Applies to: Standard-tract PCNL · Miniaturised PCNL · Supine PCNL · Prone PCNL · ECIRS · Tubeless PCNLCollecting-system perforation or urinary leak
Wire, dilator or nephroscope injury can create extravasation; inadequate drainage may lead to a persistent collection.
Applies to: Standard-tract PCNL · Miniaturised PCNL · Supine PCNL · Prone PCNL · ECIRS · Tubeless PCNLResidual stone or need for staged treatment
Complex calyceal distribution, bleeding or safety limits may prevent complete clearance in one session.
Applies to: Standard-tract PCNL · Miniaturised PCNL · Supine PCNL · Prone PCNL · ECIRS · Tubeless PCNLTract or access loss
Wire displacement or sheath movement can eliminate safe access and create parenchymal or extrarenal passage.
Applies to: Standard-tract PCNL · Miniaturised PCNL · Supine PCNL · Prone PCNL · ECIRS · Tubeless PCNLDrainage failure after tubeless exit
Omitted external drainage may expose unrecognised bleeding, oedema, obstruction or collecting-system injury.
Applies to: Tubeless PCNLSemirigid ureteroscopy and ureteric stone treatment
Ureteric perforation or extravasation
A wire, instrument, basket or laser can breach the ureter, especially beside an impacted stone.
Applies to: Semirigid URS with basket extraction · Semirigid URS with laser lithotripsy · Emergency drainage-first URS · Staged semirigid URSUreteric avulsion
Forceful scope passage or traction on an entrapped stone or basket can cause catastrophic ureteric separation.
Applies to: Semirigid URS with basket extraction · Semirigid URS with laser lithotripsy · Staged semirigid URSUrinary infection or sepsis
Instrumentation and intrarenal pressure can disseminate infection; treatment in an inadequately drained infected system is particularly hazardous.
Applies to: Semirigid URS with basket extraction · Semirigid URS with laser lithotripsy · Emergency drainage-first URS · Staged semirigid URSStone retropulsion or residual fragments
A stone may migrate beyond semirigid reach or fragments may remain and require surveillance or another procedure.
Applies to: Semirigid URS with basket extraction · Semirigid URS with laser lithotripsy · Staged semirigid URSBasket entrapment or device failure
A basket can become trapped around a large stone or fail, creating traction risk and a need for an alternative retrieval plan.
Applies to: Semirigid URS with basket extractionPost-procedure pain, haematuria or obstruction
Oedema, fragments, clot or stent symptoms can produce colic, bleeding and impaired drainage.
Applies to: Semirigid URS with basket extraction · Semirigid URS with laser lithotripsy · Emergency drainage-first URS · Staged semirigid URSUreteric stricture
Impaction, ischaemia, perforation and thermal or mechanical injury may heal with delayed narrowing.
Applies to: Semirigid URS with basket extraction · Semirigid URS with laser lithotripsy · Emergency drainage-first URS · Staged semirigid URSShock-wave lithotripsy
Steinstrasse and ureteric obstruction
A column of fragments may obstruct the ureter and cause pain, impaired renal drainage or infection; a stent does not eliminate the risk.
Applies to: Fluoroscopy-targeted SWL · Ultrasound-targeted SWL · Stented SWL pathway · Repeat-session SWLRenal or perirenal haematoma
Shock waves can injure renal tissue and vessels, producing haematuria or clinically important concealed bleeding.
Applies to: Fluoroscopy-targeted SWL · Ultrasound-targeted SWL · Stented SWL pathway · Repeat-session SWLUrinary infection or sepsis
Fragmentation may release bacteria or create obstruction in an infected system.
Applies to: Fluoroscopy-targeted SWL · Ultrasound-targeted SWL · Stented SWL pathway · Repeat-session SWLResidual fragments or treatment failure
Unfavourable composition, size, location, anatomy or targeting can leave clinically relevant stone and require another treatment.
Applies to: Fluoroscopy-targeted SWL · Ultrasound-targeted SWL · Stented SWL pathway · Repeat-session SWLPain, bruising and transient haematuria
Shock entry and fragment passage may cause flank bruising, urinary bleeding and renal colic.
Applies to: Fluoroscopy-targeted SWL · Ultrasound-targeted SWL · Stented SWL pathway · Repeat-session SWLAdjacent-organ or rhythm-related event
Poor focusing can expose neighbouring tissues, while shock delivery may interact with cardiac rhythm in susceptible circumstances.
Applies to: Fluoroscopy-targeted SWL · Ultrasound-targeted SWL · Stented SWL pathway · Repeat-session SWLStent symptoms or encrustation
An indwelling stent adds urinary symptoms, infection, migration and delayed-removal risks independent of the shock-wave session.
Applies to: Stented SWL pathway