Mortality following endoscopic management of symptomatic urolithiasis over a 10-year period: a single-centre retrospective cohort and case series.

BACKGROUND

Endoscopic management, ureteroscopy (URS), retrograde intrarenal surgery (RIRS), and ureteric stenting, is central to the treatment of symptomatic urolithiasis. Serious complications, particularly those associated with infected obstruction, remain a clinical concern. Accurate estimation of procedure-related mortality is limited by heterogeneous reporting, selected cohorts, and incomplete capture of emergency presentations. Population-level data spanning extended time periods are therefore required to characterise mortality risk in routine practice.

MATERIALS AND

METHODS

We performed a 10-year retrospective cohort study including all endoscopic interventions for symptomatic ureteric or renal calculi at a tertiary centre (1 January 2015-30 June 2025). Procedures were categorised as URS/RIRS or ureteric stent insertion alone. Demographic and operative variables were extracted from a complete theatre registry. All in-hospital deaths were identified through clinical records and reviewed as a structured case series. Analyses were descriptive and based on complete procedural activity across the 10-year period.

RESULTS

A total of 3,656 procedures were performed: 3,244 (88.8%) URS/RIRS and 412 (11.2%) stent-only. Emergency procedures comprised 58.4% (n = 2,136). Five in-hospital deaths occurred, yielding an overall mortality rate of 0.14% (1.37 per 1,000; 95% CI 0.44-3.19). Three deaths followed emergency decompression for infected obstruction, corresponding to 0.14% (1.40 per 1,000; 95% CI 0.29-4.10) mortality in emergency cases, and all involved profound sepsis physiology at presentation. Two deaths occurred after elective procedures in patients with major cardiovascular or multisystem comorbidity (0.13%; 1.32 per 1,000; 95% CI 0.16-4.74).

CONCLUSION

In-hospital mortality following retrograde endoscopic management of urolithiasis is rare. Fatal outcomes were confined to patients with advanced sepsis at presentation or major physiological vulnerability. These findings highlight the critical importance of early sepsis recognition, rapid decompression, targeted peri-operative optimisation, and MDT planning in high-risk patients.