While kidney stone disease is common and ureteroscopy (URS) is perceived as minimally invasive, there is mortality associated with treatment.
The aim of this review was to ascertain the number of mortalities from URS for stone disease over the past three decades, identify relevant patient risk factors and predictors of mortality, and summarise the key recommendations so that similar instances can be avoided, and lessons can be learnt.
A systematic literature search was conducted following Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) methodology for English-language article reporting on data from 1990 to December 2020. Data collated from each study included patient and stone characteristics, number of mortalities, and cause of death.
Fifteen studies met our inclusion criteria and revealed a total of 72 mortalities from ten countries. The age range of reported patients varied from 21 to 89 yr, with over 60% being above 65 yr of age and 97% with some comorbidity. Based on available data, death reports in females were three times more than those in males. The stone size ranged from 10 to 38 mm. Treatment of larger stones corresponded to a longer operative time, with procedural duration varying from 30 to 120 min. Of the reported causes of mortality in 42 patients, the aetiology was sepsis in over half of the patients, with other causes being cardiac-related, respiratory-related, multiorgan failure, and haemorrhagic complications.
Although the reported URS mortality rate seems to be low, there has been a rise in deaths over the past decade. Efforts must be made to have preoperative urine culture, and reduce operative time and stage procedures in patients with a large stone burden. Care must be taken in patients with robust preoperative assessment, intraoperative techniques, and postoperative monitoring for early detection of complications with interdisciplinary management of complex cases.
We reviewed the risk factors associated with postureteroscopy mortality and ways to minimise this. Evidence shows that although reported mortality remains low, there seems to be an increase in morality in the past decade and urologists must remain vigilant of this.
European urology focus. 2021 Mar 03 [Epub ahead of print]
Radhika Bhanot, Amelia Pietropaolo, Theodoros Tokas, Panagiotis Kallidonis, Andreas Skolarikos, Etienne Xavier Keller, Vincent De Coninck, Olivier Traxer, Ali Gozen, Kemal Sarica, Lily Whitehurst, Bhaskar K Somani
University Hospital Southampton NHS Trust, Southampton, UK., Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria; Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group., Urology, University of Patras, Patras, Greece., University of Athens, Athens, Greece., University Hospital Zurich, University of Zurich, Zurich, Switzerland., Department of Urology, AZ Klina, Brasschaat, Belgium., GRC n°20 LITHIASE RENALE, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France., Medical Clinic Heilbronn, University of Heidelberg, Heidelberg, Germany., Department of Urology, Medical School, Biruni University, Istanbul, Turkey., University Hospital Southampton NHS Trust, Southampton, UK; Manipal Academy of Higher Education, Manipal, India. Electronic address: .