Prospective Evaluation and Classification of Ureteral Wall Injuries Resulting from Insertion of a Ureteral Access Sheath During Retrograde Intrarenal Surgery

Data on a total of 359 consecutive patients who underwent retrograde intrarenal surgery for kidney stone were prospectively collected at 2 academic centers. We propose what is to our knowledge a novel endoscopic classification of iatrogenic ureteral wall injury. Ureteral injuries after retrograde intrarenal surgery were assessed visually with a digital flexible ureterorenoscope. The primary outcome measure was the incidence and nature of ureteral injuries. We sought factors predisposing to such injuries.

Ureteral wall injury was found in 167 patients (46.5%). Severe injury involving the smooth muscle layers was observed in 48 patients (13.3%). Males vs females (p = 0.024) and older vs younger patients (p = 0.018) were at higher risk for severe ureteral access sheath related ureteral injury. The most significant predictor of severe injury was absent ureteral Double-J® stenting before retrograde intrarenal surgery (p