Mortality from ureteroscopy for kidney stone disease: systematic review of literature from the section of EAU endourology.

purposeThe aim of this study was to ascertain the mortality associated with ureteroscopy (URS) in the management of kidney stone disease (KSD), with a focus to identify relevant risk factors and highlight key learning points to prevent and reduce mortality from URS.

methodsA literature search was conducted across Medline, Embase, CINAHL and Cochrane library, in line with PRISMA guidelines. This study focused on mortality of patients that underwent URS for KSD. Inclusion criteria included English articles of adult and paediatric patients which reported on mortality from URS. Data extracted included patient demographics, co-morbidities, procedure characteristics, number of deaths, complications, and cause of death.

resultsAfter screening, 24 articles were eligible and reported on 1,057,707 patients, across all continents. A total of 1,009 deaths were reported following URS. Sepsis and infection were the most common cause of death in 84.5% of reported cases. The key insights affecting mortality were grouped into two domains: patient factors and operative factors. The former included older age, co-morbidities, and the importance of comprehensive assessment for treatment decisions. The latter focused on infection screening, appropriate prophylactic antibiotics, reduced intrarenal pressure, use of ureteral access sheaths, timely stent removal and infection management.

conclusionInfection and urosepsis are major contributors of mortality following ureteroscopy. Efforts must be made pre and peri operatively to mitigate these. Special care must be taken in the elderly and patients with comorbidities.