SECONDARY URETEROSCOPY: RESULTS AND MANAGEMENT STRATEGY AT A REFERRAL CENTER

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Abstract
Purpose: In an era when extracorporeal shock wave lithotripsy occupies a dominant place in the treatment of urolithiasis ureteroscopy retains an important role in certain circumstances. While often a definitive procedure, ureteroscopy can be associated with potential risks and complications. The treatment of patients who have undergone a failed attempt at ureteroscopic stone retrieval or have a complication may be complex. As a tertiary care stone referral center we review our experience with performing salvage ureteroscopy following a previous unsuccessful attempt at endoscopic stone removal. Materials and Methods: Between May 1990 and February 1996, 79 patients were referred following an unsuccessful attempt at retrograde endoscopic or basket manipulation for ureteral calculi. A retrospective review of the outcomes of these patients was conducted. Of the patients 11 presented with associated complications, which included ureteral perforation [4] , intramural false passage [1] and fever or sepsis [6] . Complications were managed by early establishment of urinary tract drainage by stenting or nephrostomy. Among patients without complications elective salvage ureteroscopy was performed. Results: Ureteroscopy was used in 79 patients with a successful outcome (stone-free) in 75 (95%). Followup imaging with renal ultrasound or excretory urography at least 3 months after secondary ureteroscopy was available in 65 patients and showed no evidence of hydronephrosis or delayed stricture formation. Conclusions: Treating the patient who undergoes a failed attempt at ureteroscopy may be problematic and requires access to a wide array of endourological equipment. Each subsequent treatment should be individualized with consideration given to stone size, location and general health. In the presence of a ureteral injury establishment of early urinary tract drainage is essential. Following stabilization, secondary ureteroscopy can be performed yielding high stone-free rates with minimal complications.