ABSTRACT
Objective To analyze the peroperative injuries encountered during ureterorenoscopy (URS) in two training centers in Egypt over a four-month period. Patients and Methods A prospective computerized database of 88 patients (38 males and 50 females) who underwent URS at two urologic university training centers (Al-Azhar University Hospital; Cairo and Assiut University Hospital; Assiut; Egypt) between July and October 2003 was analyzed. The procedures were elective in all cases. The indication for URS; the state of the ureter; associated pathologies; intraoperative injuries encountered and their management were recorded for analysis. Results All but seven patients were operated for therapeutic indications; mainly stone disease and ureteric strictures. Peroperative injuries were encountered in 14 patients (15.9) with the commonest type being mucosal laceration (57) followed by minor ureteric perforations. Major injuries in the form of ureteric avulsion; laceration and extravasation were noted in 2of the cases. The procedure was associated with inadvertent bladder or urethral injury in three patients. In all cases the diagnosis of the ureteric injury was prompt and confirmed by intraoperative ureterography. Treatment was started immediately. Conclusion URS; although an important tool in the management of upper tract pathology; is an invasive procedure; especially for therapeutic indications. It may result in significant complications that may jeopardize the integrity of the concerned renal unit. Recent technology in the design of ureteroscopes and their accessories may minimize injuries; especially if applied in teaching hospitals where the learning curve of URS is a demanding task