Complications of pneumatic ureterolithotripsy in the early postoperative period

To document the perioperative and early postoperative complications of pneumatic ureterolithotripsy. Between January 1997 and December 2003, pneumatic ureterolithotripsy was performed in 665 male and 314 female patients for stones >0.5 cm. The age range was 9 months to 72 years (mean 41 years). Preoperatively, intravenous urography, urinalysis, and urine culture were done. Cefepime 1 g was given as prophylactic antimicrobial therapy 1 hour prior to surgery. A plain film of the urinary tract was taken immediately before the procedure. The operations were carried out with the patient under general anesthesia. Rigid ureteroscopes (6.9F ACMI "micro-6" or 8F-10F Storz) and the Vibrolith (Elmed, Ankara, Turkey) pneumatic lithotripter were used. The fragments were extracted with forceps or baskets. Urinalysis and culture as a routine postoperative evaluation and a plain film or ultrasonogram of the urinary tract when needed were done 1 week after the procedure. The stones were completely removed in 847 patients (86.5%); 783 (80%) of them went home on the day of surgery. A ureteral stent was needed in 401 patients (41.0%). Perioperative complications were migration of the stone into the kidney in 70 patients (7.2%), mucosal damage in 34 (3.5%), ureteral perforation in 17 (1.7%), ureteral avulsion in 4 (0.4%), and conversion to open surgery in 3 (0.2%). During the early postoperative period, flank pain (18.4%), pelvic discomfort (5.5%), macroscopic hematuria (7.3%), and urinary tract infection (5%) were recorded. Ureterolithotripsy by a pneumatic lithotripter is a minimally invasive, highly tolerable procedure with a low complication rate and short hospital stay when performed meticulously with appropriate instruments.