Ureteroscopy in the elderly: safety and functional results.

PURPOSE: To evaluate the effectiveness and safety of ureteroscopy (URS) for urinary stones treatment in patients ≥ 80 years of age. METHODS: From 2012 to 2021, 96 patients ≥ 80 years underwent URS for urinary stone disease. Patients' demographics and surgical outcomes were examined. RESULTS: The median length of follow-up was 25 months. Median age was 84 years. Half of the patients (53%) were ASA score 3 and 16% ASA 4. Mean stone diameter (SD) was 10.6 mm, and mean procedure time was 78 min. Eighty-three patients underwent follow-up imaging (ultrasonography or computed tomography) with a median time of 31 days. Stone-free rate was 73.9%. Twenty patients (20.7%) experienced a minor complication [Clavien-Dindo (CD) I-II] whereas five (5.7%) experienced a major complication (CD III-V). SD ≥ 10 mm predicted CD III-V complications (OR 1.25, 95% CI 1.01-1.55, p = 0.03). Urinary drainage prior the procedure with double J stent, nephroureteral stent or percutaneous nephrostomy tube had no impact on patients' SFR [74.6% in the drained group versus 64.0% in the undrained group (p = 0.44)] nor on major complications (OR 4.68, 95% CI 0.25-87.77, p = 0.30). CONCLUSION: In elderly patients, URS for treatment of renal and ureteral stones is a relatively efficient and safe procedure. The risk of major complications is low, and the only associated risk factor found was SD ≥ 10 mm. Urinary drainage prior the procedure did not affect patients' outcomes.

Urosepsis and abscess in an adult with a triplicated renal collecting system treated percutaneously and endoscopically.

Ureteral triplication is an extremely rare congenital disorder of the urinary tract. A review of the literature has shown that only about 100 cases have been reported worldwide. We present a case of a 50-year-old female with a known complete ureteral duplication on the right side and incomplete ureteral triplication on the left side that presented with signs of sepsis accompanied by a tender left flank mass. A detailed evaluation including imaging studies and endoscopy revealed a middle moiety obstruction causing abscess formation in the collecting system. A connection between the mid and lower moieties was demonstrated through an upper calyx of the lower moiety. The abscess was drained, and the patient further underwent ureteral stents placement to both the mid and lower ureters. Following antimicrobial treatment and several weeks of maximal drainage, the connection between the moieties was obviated, with no further episodes of urinary tract infection documented in follow up.