Complications in Ureteroscopy

In a medical climate increasingly geared toward minimally invasive procedures, ureteroscopy has gained a place as a primary treatment modality for an array of urologic applications including stone disease, ureteropelvic junction obstruction, and upper urinary tract transitionalcell carcinoma. Ureteral intussusception refers to the telescoping of mucosa after circumferential injury weakens the ureteral wall. Reports are infrequent and generally are spontaneous due to a ureteral tumor such as transitional cell carcinoma, polyp, or inverted papilloma. False passage describes perforation of the ureteral mucosa and submucosal tunneling of the offending instrument without full penetration through the ureteral wall. Excessive force and improper placement of the ureteroscope, in particular when entering the ureteral orifice, can easily result in a false passage necessitating termination of the procedure. Ureteral perforations and avulsions can lead to varying amounts of extravasation. Commonly, urine, irrigant, contrast, and blood can travel into the retroperitoneal space but calculi and tumor can also be propelled through the ureter.