Retrospective Analysis of Ureteric Injury During Ureteroscopy (URS) Versus Retrograde Intrarenal Surgery (RIRS) Over a Three-Year Period
Authors
Dr Prashant Pattnaik, Yashraj Sapkal, Dhaval Gosalia, Sameer DeshmukhFiles
Key Information
Journal
Published in Vol. 67 No. 3 (2025) of Bombay Hospital Journal.
Bombay Hospital Journal (BHJ) is a peer-reviewed quarterly published Print and Online journal. It is an official Journal of Bombay Hospital institute of medical sciences. The aim of BHJ is to improve medical care by publishing sound scientific articles (both research and practice papers) and focusing on topics that are of great importance to its readership.
Editor-in-Chief- Dr Satish Vasant Khadilkar
About the JournalAbstract
Background
Ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) are widely used minimally invasive procedures for urolithiasis. Ureteric injury remains a significant complication with potential long-term morbidity.
Objective
To compare the incidence and severity of ureteric injury during URS and RIRS over a three-year period.
Materials and Methods
A retrospective analysis of 400 patients undergoing endourological stone surgery was performed. Two hundred patients each underwent URS and RIRS. Ureteric injuries were graded intraoperatively and postoperatively as: Grade 1—superficial mucosal abrasion; Grade 2—mucosal injury; Grade 3—partial disruption; Grade 4—total avulsion. Statistical analysis was performed using the Chi-square test.
Results
Ureteric injury occurred in 30 patients (15%) in the URS group and 10 patients (5%) in the RIRS group (p = 0.0015). Low-grade injuries (Grade 1–2) constituted the majority in both groups. Severe injuries (Grade 3–4) were significantly more common in the URS group (26.7% vs 10%). No Grade 4 injury was observed in the RIRS group.
Conclusion
URS is associated with a significantly higher incidence and severity of ureteric injury compared to RIRS. RIRS appears to be a safer modality with respect to ureteric integrity.
Keywords: Endourology, RIRS, ureteroscopy, ureteric injury
References
Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath. J Urol. 2013;189(2):580-584.
Perez Castro E, Osther PJ, Jinga V, et al. Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or renal stones: the CROES URS Global Study. Eur Urol. 2014;66(1):102-109.
Preminger GM, Tiselius HG, Assimos DG, et al. 2016 AUA guideline on surgical management of stones. J Urol. 2016;196(4):1153-1160.
Türk C, Neisius A, Petřík A, et al. EAU Guidelines on Urolithiasis. Eur Urol. 2023.
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