Categorization of intraoperative ureteroscopy complications using modified Satava classification system

World J Urol. 2014 Feb;32(1):131-6. doi: 10.1007/s00345-013-1054-y. Epub 2013 Mar 17.


Objectives: To review our experience with ureteroscopy (URS) in the treatment of ureteral calculi and stratify intraoperative complications of URS according to the modified Satava classification system.

Patients and methods: We performed a retrospective analysis of 1,208 patients (672 males and 536 females), with a mean age of 43.1 years (range 1-78), who underwent ureteroscopic procedures for removal of ureteral stones. Intraoperative complications were recorded according to modified Satava classification system. Grade 1 complications included incidents without consequences for the patient; grade 2 complications, which are treated intraoperatively with endoscopic surgery (grade 2a) or required endoscopic re-treatment (grade 2b); and grade 3 complications included incidents requiring open or laparoscopic surgery.

Results: The stones were completely removed in 1,067 (88.3%) patients after primary procedure by either simple extraction or after fragmentation. The overall incidence of intraoperative complications was 12.6%. The most common complications were proximal stone migration (3.9%), mucosal injury (2.8%), bleeding (1.9%), inability to reach stone (1.8%), malfunctioning or breakage of instruments (0.8%), ureteral perforation (0.8%) and ureteral avulsion (0.16%). According to modified Satava classification system, there were 4.5% grade 1; 4.4% grade 2a; 3.2% grade 2b; and 0.57% grade 3 complications.

Conclusion: We think that modified Satava classification is a quick and simple system for describing the severity of intraoperative URS complications and this grading system will facilitate a better comparison for the surgical outcomes obtained from different centers.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Equipment Failure / statistics & numerical data
  • Female
  • Hemorrhage / epidemiology
  • Humans
  • Hysteroscopy / adverse effects*
  • Incidence
  • Infant
  • Intraoperative Complications / classification*
  • Intraoperative Complications / epidemiology
  • Male
  • Middle Aged
  • Retrospective Studies
  • Ureter / injuries
  • Ureteral Calculi / surgery*
  • Young Adult