World J Urol (2017) 35:675–681 DOI 10.1007/s00345-016-1909-0


Complications associated with ureterorenoscopy (URS) related to treatment of urolithiasis: the Clinical Research Office of Endourological Society URS Global study B. K. Somani1 · G. Giusti2 · Y. Sun3 · P. J. Osther4 · M. Frank5 · M. De Sio6 · B. Turna7 · J. de la Rosette8 

Received: 19 May 2016 / Accepted: 25 July 2016 / Published online: 4 August 2016 © The Author(s) 2016. This article is published with open access at

Abstract  Introduction Ureterorenoscopy (URS) is a popular and growing option for management of ureteric and renal stones. The CROES URS Global Study was set up to assess the outcomes of URS in a large worldwide cohort of patients involving multiple centres. In this paper, we analysed the database for intra-operative and post-operative complications associated with ureterorenoscopy. Methods The CROES database was established via collaboration between 114 centres in 32 countries worldwide, and information on both intra-operative and post-operative complications was collected electronically between January 2010 and October 2012. Result  On analysis of a total of 11,885 patients, the overall complication and stone-free rates were found to be 7.4 and 85.6 %, respectively. The intra-operative and post-operative complication rates were 4.2 and 2.6 %, respectively, and in * J. de la Rosette [email protected] 1

Department of Urology, University Hospital Southampton, Southampton, UK


Department of Urology, IRCCS San Raffaele Scientific Institute, Ville Turro Division, Milan, Italy


Department of Urology, Changhai Hospital, Shanghai, China


Department of Urology, Lillebaelt Hospital, Fredericia, Denmark


Department of Urology, City Hospital Number 40, Yekaterinburg, Russia


Urology Unit, Second University of Naples, Naples, Italy


Department of Urology, Ege University School of Medicine, Izmir, Turkey


Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ Amsterdam Z‑O, The Netherlands

total 5 deaths were reported in the study period. Taking into account different world economies, there were no differences in the complication rates between the developing and developed nations or between different centres from different continents. Conclusion  Ureterorenoscopy is a safe and effective procedure for treatment of stones, the outcomes of which are broadly comparable in different parts of the world for similar patient and stone demographics. Keywords  Ureterorenoscopy · Complications · Clavien– Dindo · Urolithiasis Abbreviations AMI Acute myocardial infarction CRF Case report form CROES  Clinical Research Office of Endourological Society CVA Cerebro-vascular accident CVD Cardiovascular disease DM Diabetes mellitus EHL Electro-hydraulic lithotripsy LOHS Length of hospital stay PNL Percutaneous nephrolithotomy SFR Stone-free rate SWL Shockwave lithotripsy URS Ureterorenoscopy US Ultrasound UTI Urinary tract infection

Introduction Ureterorenoscopy (URS) is used for management of urolithiasis and is often preferred due to its higher stone-free rate



(SFR) compared to shockwave lithotripsy (SWL), and lower complication rate compared to percutaneous nephrolithotomy (PNL) [1]. Most important complications of ureterorenoscopy are up-migration [1, 2] of stones, higher retreatment rates [1] due to incompletely removed stones (specifically in larger stones), and damage to the ureter [1–3] (from minor mucosal damage to avulsion) as a consequence of access sheath placement or difficulties with negotiating the ureter and rarely due to repetitive in and out movement of instruments. Most recent guidelines [4] state that the overall complication rate after URS is 9–25 %. Most complications are minor and do not require intervention, and ureteral avulsion and strictures are rare (15 mm: a single surgeon experience. Urol Int 96(1):77–82 2. Ibrahim AK (2015) Reporting ureteroscopy complications using the modified Clavien classification system. Urol Ann 7:53–57. doi:10.4103/0974-7796.148611 3. Ordon M, Schuler TD, Honey RJD (2011) Ureteral avulsion during contemporary ureteroscopic stone management: “the scabbard avulsion”. J Endourol 25:1259–1262. doi:10.1089/ end.2011.0008 4. Türk C, Petrˇík A, Sarica K et al (2015) EAU guidelines on interventional treatment for urolithiasis. Eur Urol. doi:10.1016/j. eururo.2015.07.041 5. Clavien P, Sanabria J, Strasberg S (1992) Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 111:518 6. Dindo D, Demartines N, Clavien P (2004) Classification of surgical complications. Ann Surg 240:205–213 7. Tepeler A, Resorlu B, Sahin T et al (2014) Categorization of intraoperative ureteroscopy complications using modified Satava

681 classification system. World J Urol 32:131–136. doi:10.1007/ s00345-013-1054-y 8. Schoenthaler M, Wilhelm K, Kuehhas FE et al (2012) Postureteroscopic lesion scale: a new management modified organ injury scale—evaluation in 435 ureteroscopic patients. J Endourol 26:1425–1430. doi:10.1089/end.2012.0227 9. de la Rosette J, Denstedt J, Geavlete P et al (2013) The clinical research office of the endourological society ureteroscopy global study: indications, complications, and outcomes in 11,885 patients. J Endourol 28:131–139. doi:10.1089/end.2013.0436 10. von Elm E, Altman DG, Egger M et al (2007) The Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457. doi:10.1016/ S0140-6736(07)61602-X 11. Garg M, Nagathan D, Goel A (2012) Re: postureteroscopic Lesion Scale (PULS): a new management modified organ injury scale—evaluation in 435 ureteroscopic patients. J Endourol 27:504. doi:10.1089/end.2012.0479 12. Hubosky SG, Raval AJ, Bagley DH (2015) Locked deflec tion during flexible ureteroscopy: incidence and elucidation of the mechanism of an underreported complication. J Endourol 29:907–912. doi:10.1089/end.2015.0074 13. Zargar-Shoshtari K, Anderson W, Rice M (2015) Role of emergency ureteroscopy in the management of ureteric stones: analysis of 394 cases. BJU Int 115:946–950. doi:10.1111/bju.12841 14. Labate G, Modi P, Timoney A et al (2011) The percutaneous nephrolithotomy global study: classification of complications. J Endourol 25:1275–1280. doi:10.1089/end.2011.0067


Complications associated with ureterorenoscopy (URS) related to treatment of urolithiasis: the Clinical Research Office of Endourological Society URS Global study.

Ureterorenoscopy (URS) is a popular and growing option for management of ureteric and renal stones. The CROES URS Global Study was set up to assess th...
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