From the Guidelines
The risk of significant bleeding complications associated with a diagnostic ureteroscopy is low, particularly for patients who require continuation of aspirin, as stated in the study by 1. When considering the risk of bleeding associated with a diagnostic ureteroscopy, several factors come into play, including the use of anticoagulant medications, the presence of bleeding disorders, and the technical aspects of the procedure itself.
- The study by 1 suggests that the risk of significant bleeding complications is low for patients who require continuation of aspirin for ureteroscopy.
- Diagnostic ureteroscopy typically involves less manipulation of the urinary tract compared to therapeutic procedures, which contributes to its lower bleeding risk.
- Most patients experience some degree of microscopic hematuria (blood in the urine) following the procedure, but this is usually self-limiting and resolves within a few days.
- Gross hematuria (visible blood in the urine) is less common but can occur in a small percentage of cases.
- Factors that may increase bleeding risk include anticoagulant use, bleeding disorders, large stone burden (if present), and prolonged procedure time.
- To minimize bleeding risk, patients should follow their physician's instructions regarding the discontinuation of blood thinners like aspirin or warfarin before the procedure.
- Urologists can further reduce the risk of bleeding by using small-caliber, flexible ureteroscopes and maintaining good visualization throughout the procedure.
- In the rare event of significant bleeding, it can usually be managed conservatively with hydration and temporary ureteral stenting, as noted in the study by 1.
From the Research
Risk of Bleeding Associated with Diagnostic Ureteroscopy
- The risk of bleeding-related complications following ureteroscopy has been evaluated in several studies 2, 3, 4, 5.
- A study published in 2017 found that the overall bleeding-related complication rate was 8.1%, with a significant bleeding-related event rate of 5.9% 2.
- Another study published in 2016 found that the overall bleeding-related complication rate was 1.9%, with a significant bleeding-related event rate of 1.6% 3.
- A 2013 study found no difference in bleeding complications between patients on antiplatelet and anticoagulant therapy and those not on these medications 4.
- A 2021 study found that anticoagulant therapy was not associated with increased risk of hospitalization, but antiplatelet therapy was associated with a significantly increased risk of hospitalization (OR 1.48,95% CI 1.02-2.14) 5.
- A 2020 review of complications associated with ureteroscopy found that ureteral wall injury and stone migration are common complications, but did not provide specific data on bleeding-related complications 6.
Factors Influencing Bleeding Risk
- The use of anticoagulant and antiplatelet therapy may influence the risk of bleeding-related complications following ureteroscopy 2, 3, 4, 5.
- The type and dosage of anticoagulant and antiplatelet therapy may also impact the risk of bleeding-related complications 5.
- Patient factors, such as age and comorbidities, may also influence the risk of bleeding-related complications following ureteroscopy 2, 3, 4.