Cindolo Luca, Castellan Pietro, Scoffone Cesare Marco, Cracco Cecilia Maria, Celia Antonio, Paccaduscio Andrea, Schips Luigi, Proietti Silvia, Breda Alberto, Giusti Guido
Department of Urology, "S. Pio da Pietrelcina" Hospital, Via San Camillo de Lellis 1, 66054, Vasto, Italy.
Department of Urology, "SS. Annunziata" Hospital, Chieti, Italy.
World J Urol. 2016 Mar;34(3):305-10. doi: 10.1007/s00345-015-1642-0. Epub 2015 Jul 26.
Advancements in the endourological equipment have made retrograde intrarenal surgery (RIRS) an attractive, widespread technique, capable of competing with traditional shock wave lithotripsy and percutaneous nephrolithotomy. Since the complication rate is generally low, even less is known about dramatic and fatal complications after RIRS.
We performed a survey asking 11 experienced endourologists to review their RIRS series and report the cases of mortality to their best knowledge.
Six urologists reported on six fatal cases. In three cases, a history of urinary tract infections was present. Four patients died from urosepsis, one due to an anesthetic and one due to hemorrhagic complication. The use of ureteral access sheath was not common.
Even respecting the standards of care, it may happen that physicians are occasionally tempted to overdo for their patients, sometimes skipping safety rules with an inevitable increase in risks. Despite the fact that RIRS has become a viable option for the treatment of the majority of kidney stones, its complication rates remain low. Nevertheless, rare fatal events may occur, especially in complex cases with a history of urinary tract infections, and advanced neurological diseases.
腔内泌尿外科设备的进步使逆行性肾内手术（RIRS）成为一种有吸引力且广泛应用的技术，能够与传统的冲击波碎石术和经皮肾镜取石术相竞争。由于并发症发生率通常较低，关于RIRS术后严重及致命并发症的了解甚至更少。
我们进行了一项调查，邀请11位经验丰富的腔内泌尿外科医生回顾他们的RIRS病例系列，并尽其所知报告死亡病例。
六位泌尿外科医生报告了六例致命病例。三例存在尿路感染病史。四名患者死于尿脓毒症，一名死于麻醉，一名死于出血并发症。输尿管通路鞘的使用并不常见。
即使遵循护理标准，医生有时可能会忍不住为患者过度治疗，有时会跳过安全规则，不可避免地增加风险。尽管RIRS已成为大多数肾结石治疗的可行选择，但其并发症发生率仍然较低。然而，罕见的致命事件可能会发生，尤其是在有尿路感染病史和晚期神经系统疾病的复杂病例中。
