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Objective:Ureteral stents inserted to prevent obstruction to the flow of urine need to be removed after they serve the purpose of their insertion. The most commonly practiced method for stent removal is using a rigid cystoscope in an office setting. However, it is quite painful and may require general anesthesia especially in males. Due to their small caliber, rigid ureteroscope can reduce patient discomfort during ureteral stent retrieval procedure. In this study, we compared the pain scores during ureteral stent retrieval using a rigid cystoscope and a rigid ureteroscope.Materials and Methods:A prospective study was conducted with 64 male patients with ureteral stents who were divided into two groups. Group A had 36 patients who underwent stent retrieval with rigid cystoscope while group B had 28 patients who underwent with rigid ureteroscope. Pain experienced during the procedure and during the first void thereafter were recorded using visual analog scale.Results:The patients who underwent stent retrieval using rigid cystoscope (mean 7.05±1.21) had a significantly higher (p

Cystic dilatation of Cowper’s glands, also known as a syringocele, is a well-known condition of childhood, with increased recognition as a rare presentation of urinary tract symptoms in adults. Surgical techniques for its treatment vary, with several described in the literature. However, consensus on optimal treatment is unclear. We present a rare case of a Cowper’s gland syringocele successfully treated with laser deroofing with a previously undescribed method using a rigid ureteroscope, and we also review techniques in the literature. Level of evidence: Level 5.

Introduction: Ureteral stones are among the most common disorders in the urologic field. Miniaturization of endoscopic devices in urology and extracorporeal shock wave lithotripsy (ESWL) has revolutionized the management of ureteral stones. The aim of this study was to compare the efficacy and results of laser versus pneumatic lithotripsy (PL) with semi-rigid ureteroscope in a randomized prospective clinical trial in removing stones. Methods: 117 adult patients underwent transurethral lithotripsy (TUL) in a single academic center and by a single surgeon. The patients were randomized in 2 groups: In group 1, 58 patients with ureteral stones underwent ureteroscopy and stone fragmentation was done by Ho: YAG laser lithotripsy (LL) and in group 2, 59 patients underwent PL (Swiss LithoClast) by using the same ureteroscope. Results: Mean age was 41.77 years and 41.1years in group one and 2 respectively (P = 0.79), there was no significant difference in male to female ratio and mean stone in both groups. The success rate for stone clearance was 79.31% and 77.96% in group 1 and 2 respectively (P = 0.52). No difference between complications was seen in both groups, but the duration of operations was different (significantly lower in group 2). Conclusion: In both techniques, acceptable results were achieved. We have found a significant statistical difference in duration of operation between our results (P = 0.001) and similar studies, while this was shorter in the pneumatic group in our study, it was longer in other similar ones. This might be a result of more experience in working with PL in our center. Keywords: Laser lithotripsy, Pneumatic lithotripsy, Ureteroscopy

WOS: 000375901500066 PubMed: 26921643 OBJECTIVE To compare the outcomes of the ureteral access sheath (UAS) placement techniques in patients undergoing retrograde intrarenal surgery. MATERIALS AND METHODS The patients were divided into two groups with respect to placement method of UAS. UAS was placed with the classical method, through the guidewire, in the first group of the patients (group I). The outer sheath of UAS was worn on the semirigid endoscope and placed into the ureter under direct vision in the second group (group II). The number of patients was the same in two groups (n = 42). RESULTS Overall, 70 of 84 (83.3%) patients were stone free after the initial treatment. The success rates were comparable between the two groups (80.9% vs 85.7%, P = .859) 1 month after surgery. Fluoroscopy screening time (11.7 +/- 5.7 seconds vs 0 second), UAS placement time (245 +/- 138.4 seconds vs 40 +/- 17.9 seconds; P < .001), and operation time (58.7 +/- 17.1 minutes vs 51.2 +/- 16.7 minutes; P = .046) were significantly longer in group I when compared to group II. The complication rate was higher in group I when compared to group II (23.8% vs 9.5%), but the difference was not statistically significant (P = .079). CONCLUSION Introducing UAS into ureter under direct vision while it was precisely worn on ureteroscope makes this step safer, and protects the surgeon and patient from radiation exposure by shortening fluoroscopy and operation times. (C) 2016 Elsevier Inc.

Obtaining a tissue diagnosis from a ureteric lesion can be technically difficult. Inadequate tissue sampling with biopsy forceps is common and can delay diagnosis and treatment. The use of backloading biopsy forceps allows larger tissue samples to be obtained when compared with traditional biopsy forceps, which are limited by the diameter of the ureteroscopic working channel. However, backloaded biopsy forceps may reduce vision and hinder safe access of the ureter. The use of an access sheath can allow multiple passes to the ureteric lesion and can improve vision.

Laparoscopic common bile duct exploration (LCBDE) is used to treat choledocholithiasis. Flexible choledochoscopy is usually performed; however, this instrument is fragile and liable to breakage.Data were collected and reviewed retrospectively from a prospectively maintained database. All cases of attempted LCBDE with the rigid ureteroscope at the institution since January 2014 were included. Demographic characteristics, preoperative attempted endoscopic retrograde cholangiopancreatography (ERCP), size of the bile duct, findings at laparoscopy, use of drain or T-tube, conversions, and morbidity or mortality were documented.A total of 37 patients were identified. The median age was 51 years (32-71). The male to female ratio was 1:5. Twenty-eight patients had failed ductal clearance at ERCP (75.7%). The mean common bile duct (CBD) diameter was 11.4 mm (10-13.5). There were five conversions. Cirrhosis in 2 patients, bleeding in 1 patient, impacted stone in 1, and equipment failure in 1. T-tubes were placed in 5% of cases. N = 8 (21.6%) of the patients had a Mirizzi syndrome. Average hospital stay was 4 days (3-7). Two patients had complications postoperatively-bleeding and collections.LCBDE using the rigid ureteroscope is feasible. It can be performed with acceptable morbidity. Use of the rigid ureteroscope represents a good alternative to the flexible choledochoscope with high duct clearance rates. One disadvantage is cirrhosis where the scope may not be negotiated into the CBD due to a stiff liver. It is a viable option when preoperative ERCP has failed to clear the CBD.

The comparison of ureteroscopy and ureterolithotomy for the treatment of large and impacted ureteral stones in the middle and upper part of ureter Objective: We aimed to research the most effective treatment method of the middle and upper ureteral impacted stones of which is 1.5-2 cm diameter size. Material and Method: Between 2000 and 2013, 75 patients who had impacted stone size of between 1.5-2cm at the middle and upper part of the ureter were examined. Patients had been analysed in terms of their demographical characteristics, stone size, hospitalization time, stone- free and complication rates. For statistical analysis Pearson’s chi-square, Mann Whitney-U and student-t tests has applied. The significance level is determined as p

A bifid ureter with a distal blind-ending branch is a rare congenital anomaly. Most patients are asymptomatic; only patients with complications, such as infection, vesicoureteral reflux, or stone formation, present symptoms. We describe the case of a patient with urinary stone located in the distal blind-ending branch of a bifid ureter diagnosed during transurethral lithotripsy. Preoperative noncontrast-enhanced computed tomography did not reveal a stone in the distal blind-ending branch of the bifid ureter, but a rigid ureteroscope did; however, it could not reach the stone. Therefore, the stone was extracted using a basket catheter under a flexible ureteroscope.

The aim of this study was to compare the success and complication rates of a 4.5 F ureteroscope with a 7.5 F ureteroscope in the treatment of urolithiasis in preschool-age children. We retrospectively reviewed 69 ureteroscopy (URS) procedures in a pediatric population (40 boys, 29 girls). We divided the patients into two groups according to the type of ureteroscope used: group 1 (n = 42, Storz 7.5 F) and group 2 (n = 27, Wolf 4.5 F). We statistically compared all the procedures performed in both groups regarding patient age, complication rates, whether the procedure was therapeutic, and whether we used a guidewire. Additionally, in cases with ureteral stones, we also compared the stone clearance rate and the necessity of X-ray imaging between the two groups. The mean patient age was 56.04 months in group 1 and 47.48 months in group 2 (p = 0.057). The stone-free rate was 78.6 % in group 1 and 92.6 % in group 2 (p > 0.05). However, when we compared the stone-free rates for patients younger than 3 years, the rate was 66.7 % in group 1 and 93.8 % in group 2 (p < 0.05). The difference was not statistically significant for patients between the ages of 4 and 7 years. The success and failure rates revealed better outcomes for treatment of ureteral stones with a 4.5 F ureteroscope. We recommend the use of the mini-ureteroscope, especially in infants and preschool-age children.

Purpose: To evaluate the indications for, and the effects of, the management of renal caliceal calculi with deflectable tip rigid ureteroscopy. Patients and Methods: We designed a new deflectable tip rigid ureteroscope, and 175 patients with renal caliceal calculi received deflectable tip rigid ureteroscopic lithotripsy with a holmium laser. Results: From December 2003 to December 2007, the procedure was successfully performed in all patients with a mean operative time of 28 minutes (range 19–45 min). The mean size of renal caliceal stones was 1.3 cm (range 0.8–2.4 cm). Seventeen patients had concurrent proximal ureteral calculi. The mean lithotripsy time was 11 minutes (range 5–22 min), and the mean discharge time was 3 days after operation. The overall stone-free rate at the 1-month follow-up was 83%. Conclusion: Ureteroscopic lithotripsy with the novel deflectable tip rigid ureteroscope is a safe procedure and combines the advantages of rigid and flexible ureteroscopy, especially for renal cal...

Management strategy for upper urinary tract calculi in small children is still a matter controversial. We report successful management of ureteral stone with transurethral ureterolithotripsy (TUL) in 2 boys weighing around 10 kg. Case 1: A 2-year-old boy (78 cm in height, 9.6 kg in weight), who received hydrocortisone and fludrocortisone for the treatment of 21-hydroxylase deficiency, was referred to our hospital with a right 9-mm lower ureteral stone. For TUL, a 7.5 Fr rigid cystoscope was introduced into the ureter directly after dilation of the ureteral orifice. By using Holmium:YAG laser for lithotripsy, complete stone evacuation was achieved. Stone analysis showed the composition of calcium phosphate and calcium oxalate. Case 2: A 1-year-old boy (80 cm in height, 10.5 kg in weight) with neurofibromatosis type 1 was referred to our hospital with a left 7.5-mm ureteral stone at the ureteropelvic junction. TUL was performed using a 4.5 F rigid ureteroscope and Holmium:YAG laser. No residual stone was identified. Stone analysis showed the composition of calcium oxalate. TUL is a safe and feasible option for small children, even in boys weighing approximately 10 kg.

Introduction Exracorporeal shockwave lithotripsy (ESWL) is the first choice for patients with urolithiasis. Increased use of endoscopic techniques provided increased use of ureteroscopic lithotripsy in the treatment of stones located in distal ureter, as well as ESWL. Rigid ureteroscope is usually used in the management of distal ureter stones, while middle and upper ureter stones should be treated by flexible ureteroscope or ESWL. At Urology Clinic in Novi Sad, ureteroscopy has been used since 1986, and more than 1000 procedures have been preformed with success rate of over 95% (100% when we were able to reach the stone). The aim of this report is to show the destruction of stone along the ureter, using a rigid ureteroscope, shortly after the ESWL treatment of kidney stones. Case report A 46-year-old woman was admitted to the Clinic with "steinstrasse" along the ureter, two weeks following ESWL of kidney stones. Primarily, she underwent ESWL without J-J stenting, at another urologic department. On admission to our Clinic, she complained of pain, nausea, mild temperature. An urgent diagnosis was carried out and left sided "steinstrasse" with hydronephrosis was confirmed by ultrasound, plain X-ray, laboratory findings. Ureteroscopy was performed under spinal anesthesia by rigid ureteroscope and the stone was destroyed along the ureter, even the pyelon was explored at the end of the procedure. The patient was advised to take a lot of fluids with diuretics and 80% of stones were eliminated in the first week after the procedure. At the first control, a month later, the patient was stone free. Conclusion Rigid ureteroscope is a therapeutic option for distal ureteral stones, just as ESWL with comparable and reproducible results. This case confirms the fact that in strictly selected cases, and careful work of skilled urologists, rigid ureteroscope can be used for successful stone destruction in the middle and upper ureter.

Ballistic lithotripsy is one of the new intracorporeal lithotripsy methods. In this study, the efficacy and complications of this method in the management of ureteral calculi were evaluated.From November 1999 to December 2001, 340 patients (mean age 39.8 years; range 1.5-82 years) with a total of 362 ureteral calculi (bilateral in 22 cases) were treated with an 8.5F rigid ureteroscope and the Swiss Lithoclast. Of the calculi, 115 (32%) were located in the upper ureter, 63 (17%) in the middle ureter, and 184 (51%) in the lower ureter. The mean stone size was 10.4 mm (range 5-22 mm).Nearly all (344; 95%) of the calculi were accessible with the ureteroscope, and 321 calculi (88.7%) were fragmented completely, either with no residual fragments or with residual fragments3 mm. In 3 cases (0.8%), there were residual fragments of about 4 mm after the procedure that passed spontaneously. Twenty calculi (5.5%) migrated to the kidney during the procedure and were subsequently treated with adjuvant SWL. Major complications occurred in 2 cases (0.54%): ureteral perforation and stenosis in 1 patient each. The 2-week stone-free rate was 89.5% (324/362).Lithoclast ballistic lithotripsy is a safe and effective approach for the treatment of ureteral calculi regardless of composition.

BACKGROUND Choledocholithiasis poses challenges to surgeons. Open CBD exploration with T tube has given way to ERCP and Laparoscopic CBD Exploration(LCBDE). Failure rate is high for large impacted stones. Improvisation in technique reduces failure rate. We publish our experience in the use of rigid ureteroscope in laparoscopic CBD exploration and assess feasibility and safety in complete clearance of CBD stones. MATERIALS AND METHODS This procedure was conducted by Unit 4 of Department of General Surgery in Sri Ramachandra Medical University,Chennai(Tamil Nadu) during 2017. Rigid Ureteroscope was used in 5 patients of choledocholithiasis for LCBDE, which was passed into CBD both proximally and distally visualising the CBD for clearance of stones. Intraoperative finding, operative time, hospital stay and complications were recorded. As per literature search this is the first series from South India using this technique. RESULTS 5 patients underwent laparoscopic common bile duct exploration. Minimum duct diameter was 10 mm. All had failed ERCP. Primary laparoscopic closure with placement of 10F biliary stent was done in all patients. Complete stone clearance achieved. Average hospital stay was 5 days. No complications occurred. CONCLUSION Use of rigid ureteroscope in LCBDE is feasible and efficacious in dealing with unsuccessful endoscopic stone extraction.

Further advances in endoscope technology have allowed the development of a new generation of tightly packed fiberoptics encased within a rigid ureteroscope. The tips of these semirigid ureteroscopes measure between 5.0F and 11.9F, and their working channels measure between 1.8F and 5.5F, which allows passage of routine endoscopc instruments. Additionally, several manufacturers have recently produced straight-channel fiberoptic semirigid endoscopes with an offset lens which allow usage of rigid lithotripsy devices. New fiber-packing techniques provide numerous pixels within the image bundle. These ureteroscopes have varied distal lens systems, but all have excellent vision in the field of view.Over the past 28 months, we have performed transurethral ureteroscopy in 187 patients, having utilized semirigid ureteroscopes in 158 patients for diagnostic procedures (8.7 %), stone manipulation (78.7 %), removal of migrated stents (4.4%), and surgery of stricture, tumor, or foreign bodies (8.2%). In more than 50% of our cases, ureteral dilation was not necessary, and the semirigid ureteroscope was passed to the area of interest without difficulty.We accessed the site of pathology in 96.2% of patients. Overall, complications occurred in 6.9% of patients. However, of these problems, 93.6% were small ureteral perforations (only three of which were caused by the semirigid ureteroscope itself), and all cases but one were managed successfully by a ureteral stent. No postoperative strictures were noted.This new generation of semirigid fiberoptic ureteroscopes represents another significant advance in the endourologic management of ureteral disease.

Purpose: We report our experience with ureteroscopy in pregnancy.Materials and Methods: From 1984 to 1994, 24 pregnant women with lasting symptoms of ureteral obstruction underwent diagnostic and therapeutic ureteroscopy. Most of the women were in the second or third trimester of gestation.Results: A rigid ureteroscope was introduced easily to the upper third of the ureter or into the renal pelvis in all patients. Ureteral calculi were extracted in 13 cases. There were no serious complications.Conclusions: Ureteroscopy is a safe procedure that may be used to diagnose and extract obstructing ureteral calculi during pregnancy when conservative measures fails.

Previously, the authors demonstrated the feasibility of a pure transvesical natural orifice translumenal endoscopic surgery (NOTES) for uterine horn resection (UHR) using a rigid ureteroscope in swine as an appendectomy model. However, visualization was poor, and there was room for improvement. The authors have assessed the feasibility and safety of a revised technique that uses a 5-mm rigid laparoscope. Eight operations on four female pigs (35–40 kg) were performed as a proof of concept study. Four right-side operations were performed in a survival model. The surgical procedure was similar to the original technique. However, the rigid ureteroscope was replaced by a 5-mm laparoscope after modification of the access system. In addition, the clipped metal threads used for bladder closure were easily placed with a long 13-gauge needle. In the survival model, a Foley catheter was placed for 1 day. The new technique provided considerably better visualization and operability than the original technique. The mean total operative time was 96.6 ± 18.2 min, and the mean estimated blood loss was 15.0 ± 13.5 ml. On postoperative day 3, pig 2 in the survival study died of peritonitis resulting from a small bowel injury. The lab results for the other pigs demonstrated no adverse events and tolerable immune responses. Necropsy showed complete healing of the vesicotomy. The revised transvesical NOTES UHR technique improved the outcomes and feasibility of the original technique. This approach may be translatable to human appendectomy procedures in the future.

OBJECTIVES To report our experience with percutanous nephrolithotomy (PCNL) in infants with renal calculi, and evaluate its safety and efficacy in this age group. METHODS We retrospectively analyzed the medical and radiological records of infants (children under 3 years of age) with renal calculi who were treated by PCNL at our institution between November 2005 and August 2010. All PCNL was primary and with one puncture, using a 8/9.8Fr rigid ureteroscope. For stone removal, 14-18 Fr percutaneous tracts were established and stones were fragmented with a pneumatic lithotripter. Stone clearance and complications were recorded. Percutaneous nephrolithotomy for managing renal calculi in infants: a single-center experience

Objective To evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL) in infants ( Methods From November 2005 to August 2010, 20 renal units with calculi in 19 infants (13 boys and 6 girls) were treated with PCNL at our institution. Mean age of infants was 20.6 months (range, 7-36 months), the mean stone size was 2.2 cm (range, 1.9-3.1 cm). All PCNL procedures were performed with 14 to 16F percutaneous access and 8/9.8F rigid ureteroscope. Stones were fragmented with a pneumatic lithotripter and evacuated. Results Mean operative time was 77.5 minutes (range, 35-120 minutes). Stones were completely removed in 85% of kidneys (17 of 20 kidneys) after the first session and 95% (19 of 20 kidneys) after a second look PCNL procedure. No patients required a blood transfusion. Evaluation of the renal function before and after the PCNL procedure demonstrated the stabilization of corresponding glomerular filtration rate in the treated kidney (48.2 ± 3.7 vs 50.4 ± 5.2 mL/min; P = .22). Conclusion When performed by experienced endourologists, PCNL is a safe and effective procedure in infants for the removal of renal calculi.

Purpose Assessment of safety and efficacy of extracorporeal shockwave lithotripsy versus semi-rigid ureteroscope with lithoclast for treatment of large proximal ureteral stones. Materials and methods The study included 147 patients with large upper ureteral stones. SWL and ureteroscopy were performed in 71 and 76 patients respectively. Patients in the SWL group were treated with Siemens: - Modularis lithovario under intravenous sedation on an out patient basis. Patients in the ureteroscopy group were treated with (7.5 Fr) semi-rigid ureteroscope and lithoclast under spinal anesthesia on a day care basis. Results Stone - free rate for in situ SWL was 58% (41 of 71) patients. For semi-rigid ureteroscope accessibility of the stones was 94% (72 of 76) and the stone free rate was 92% (70 of 76) No major complications were encountered in both groups. Mean stone size was 1.34 ± 0.03 cm in the SWL group and 1.51 ± 0.04 in the ureteroscopy group. Conclusions Our study demonstrates that ureteroscopy with lithoclast can be considered as acceptable treatment modality for large proximal ureteral calculi and can be considered as fist line for treatment of large proximal ureteral stones.

The Finlayson ureteral access system was used to facilitate passage of the 11.5F rigid ureteroscope in 31 patients (32 procedures). Patients ranged in age from 19 to 87 years. The indications were ...

Complete ureteral obstruction after pelvic surgery is traditionally managed by open repair. Recent advances in endoscopic instruments and techniques have improved the efficacy with which these conditions are treated. Here, we describe our experiences with a holmium:YAG laser in the endoscopic management of complete ureteral obstruction.Retrograde endoscopic ureteroureterostomy using a Ho:YAG laser was performed on five patients with complete ureteral obstruction having a mean length of 0.9 +/- 0.2 cm after gynecologic surgery. The obliterated segment was incised with a 550-microm fiber through a rigid ureteroscope and under fluoroscopic guidance. Afterward, balloon dilatation was performed. A 7F/14F endopyelotomy stent was maintained for a mean time of 7 weeks, and follow-up was conducted via radiologic imaging.Recanalization was possible in all five patients immediately. One month after the initial operation, one patient exhibited a normal ureteral passage, and three other patients exhibited partial ureteral stricture. The remaining patient was lost to follow-up. Of the three patients with partial strictures, two evidenced no stricture after additional endoscopic treatment(s), and the remaining patient eventually underwent open repair. Overall, three of four (75%) patients exhibited normal excretory function without any open surgery and were symptom free with a mean follow-up time of 45 months (range 23-67 months).Although the number of patients in this study was small, it appears that endoscopic ureteroureterostomy with a Ho:YAG laser may constitute a valuable option for the treatment of complete short ureteral obstructions.

Introduction: the JJ stent insertion and removal is quite common urological procedure, which could be challenging sometimes as per knot formed on proximal stent end. by using rigid 8cH ureteroscope the authors provide recommendations for difficult stent removal. case series: two cases of difficult JJ stent removal on two patients who had previously renal colic. the stents were 6cH/26cm; most common used ones. JJ stents looked unremarkably on the fluoroscopy before their retrieval. On the extraction their proximal ends formed knots, which were bigger than the diameter of the ureter. by use of short 8cH rigid ureteroscope positioned distally adjacent to the stent, sufficient dilatation of the ureter was gained. conclusion: the JJ stent removal is a delicate procedure, which nevertheless its technical simplicity could bring up unexpected complication to raise urologist’s awareness.

To describe an easily home-made diathermy probe for the performance of retrograde endopyelotomies using a small-caliber rigid ureteroscope.The diathermy probe is easily built by putting a rigid guidewire through a 5F ureteral catheter, the distal tip being naked and slightly bent. The other end is linked to the electric generator. Among a total of 24 retrograde endopyelotomies performed to treat ureteropelvic junction obstruction in the last 7 years, five were done using this device.Surgery with the probe took an average of 30 minutes. There were no complications, and, as of today, all cases are successes.This device allows the performance of retrograde endopyelotomy using a small-caliber ureteroscope. Long-term results will presumably match the good results obtained using the larger-caliber ureteroscopes with the classic cold knife.

Endopyelotomy has increasingly become well accepted as the optimal management for primary and secondary ureteropelvic junction obstruction. We report our experience with ureteroscopic endopyelotomy guided by endoluminal ultrasound.Ureteroscopic endopyelotomy was attempted in 27 patients with primary and 10 with secondary ureteropelvic junction obstruction. Retrograde pyelogram and endoluminal ultrasound were performed at the start of the procedure in all patients. Based on sonographic findings 5 patients were not considered candidates for the procedure. The remaining 13 men and 19 women were treated ureteroscopically with a rigid ureteroscope in 5 (15.6%), flexible in 20 (62.5%), and rigid and flexible in 7 (21.9%) patients. Stents were placed postoperatively for 6 to 10 weeks. The patients were followed for a mean duration of 10 months.The procedure was completed in all patients. Average operating time was 95 minutes including the time for imaging. Sonographic localization guided the site of incision in all patients and changed therapy in 5. It identified crossing vessels in 10 patients (31%), septum denoting high insertion in 5 (15.5%) and both in 7 (22%). Preoperative stenting was not required in any patient. Morbidity was low with no patients requiring transfusion and no evidence of ureteral strictures. Success, defined as pain-free with resolution of obstruction on diuretic renal scan, was achieved in 28 of the 32 patients (87.5%).Ureteroscopic endopyelotomy is a safe and effective treatment for most cases of ureteropelvic junction obstruction. Endoluminal ultrasonography of the obstructed ureteropelvic junction has gained a major role in defining which patient to treat and in directing endoluminal incisions to minimize the risk of injury to adjacent vessels. There is a higher failure rate when vessels are present.

The aim of this study was to investigate the possibility to perform bilateral ureteroscopy in one session and to determine the procedure's indications and complication rate. Twenty-two patients underwent bilateral ureteroscopy in one session. Eighteen patients had bilateral lithiasis of the lower ureteral third, three patients had unexplained haematuria and one had unexplained bilateral hydronephrosis. The rigid ureteroscope was used in cases with stones and the flexible one in cases with haematuria and hydronephrosis. Ureteral catheters were placed in all patients. The overall stone-free rate was 83.3%. The procedure failed to confirm a diagnosis in 2 patients with unexplained haematuria. Follow-up included IVU and retrograde cystogram 3 months after the procedure and a renal scan one year later. No major complication was observed. It is concluded that bilateral ureteroscopy in one session can be performed safely in selected patients. The method does not yield major complications and saves patients from a second procedure and a second anaesthesia.

A new ureteroscope design incorporates fiberoptic imaging bundles to replace the rod lens system in a rigid ureteroscope body. These ureteroscopes have evolved along two lines: instruments with a movable eyepiece and those with a small outer diameter (10F). The fiberoptic imaging bundles take up less space than the rod lens system. These ureteroscopes thus have a larger working channel than instruments of a similar outer diameter with rod lens imaging systems. Measurement of irrigation rates through a representative sample of these ureteroscopes demonstrated that gravity irrigation was adequate through the empty working channel. However, if an accessory instrument was placed in the working channel, gravity irrigation was insufficient in the smaller models. Manual irrigation was more than adequate under all conditions. The larger models now offer relatively little advantage to counter the decrease in image quality associated with the "honeycomb" fiberoptic image. Nevertheless, the more recent small ureteroscopes allow an adequate irrigant flow while accepting working instruments suitable for a variety of procedures. They thus seem to be ideal for diagnostic ureteroscopy, as they are quick and easy to use, not even requiring ureteral dilation. Furthermore, their small size does not limit their therapeutic applications; on the contrary, it expands them.

We report on 2 successful cases of ureteroscopic stone manipulation during prenancy using the rigid ureteroscope. These 2 cases are reported to show the utility of this technique when applied to low ureteral stones presenting in third trimester of pregnancy. We believe this technique is sate; both for the mother and the fetus, when carefullq applied to selected individuals.

Eleven patients with ureteral stone disease were treated transurethrally using a rigid uretero scope and ultrasonic lithotriptor. From this experience, we consider that most ureteral stones can be removed through this procedure alone or in combination with percutaneous nephrolithotripsy.

The female Hanford strain of minipig proved to be an excellent endourologic model. Cystourethroscopy was possible in all 13 animals tested, with a rigid ureteroscope the optimum instrument. Uretera...

Ultrasonic lithotripsy of ureteral calculi has been accomplished using a fine flexible ultrasonic probe under direct visual control through a 9-F rigid ureteroscope. Electrohydraulic ureterolithotripsy was performed by passing a 5-F catheter-electrode cystoscopically under fluoroscopic control. Case reports are presented. It is concluded that ultrasonic ureterolithotripsy, using the technique described, is a feasible and safe method. Although stone fragmentation by electrohydraulic ureterolithotripsy is possible, the danger of ureteral injury and urinary extravasation is appreciable.

Use of a rigid ureteroscope for extraction of 19 ureteric and 6 renal pelvic stones is reported. One of the 24 patients had bilateral ureteric stone. The extraction was successful in 22 cases, including 9 after ultrasonic disintegration of stone. Surgical removal of stone was required because of failure of the ultrasound apparatus in one case and ureteric perforation in another. One stone was extracted "blind". The method has many advantages over more established procedures. It should be the preferred technique for management of ureteric calculi, and may be an option for some renal pelvic stones.

The success rate of endoscopic manipulation of ureteral calculi is uncertain. The uncertainty arises because of selection procedures. A common reported figure is 50%, but this figure varies according to the selection procedure followed and the selection procedure depends on the anticipated difficulty of manipulation. The outcome of endoscopic manipulation performed as an initial procedure in a series of patients whose ureteral calculi required operative intervention is presented. A total of 33 calculi were successfully extracted by manipulation, including five in the upper ureter. The method failed to extract three calculi of which two were in the upper ureter. The success of this approach is attributed to the use of the rigid ureteroscope and the Meagher ureteral dilator, and to x-ray control.

Initial experience with the rigid ureteroscope showed that despite ureteral dilation and guide wire followers, introduction of the ureteroscope can be difficult due to bladder mucosa catching on the instrument. A simple, cheap disposable device using a modified ureteric catheter is presented that overcomes this problem.

Rigid transurethral ureteroscopy has been utilized on sixteen occasions for the treatment of distal ureteral calculi. This resulted in successful stone removal and avoidance of an open operation in 69 per cent of the cases. The advantages of this type of treatment are that it enables endoscopic access to a surgically difficult portion of the ureter and allows direct visualization during basket manipulation of ureteral calculi.

Between July, 1986 and July, 1987, 128 patients with large impacted ureteral stones or persistent Steinstrasse required ureterolithotripsy at UCLA (Table 1). Indications were: failed stone manipulation with or without ESWL for stones located a) above the iliac crest, b) in the true pelvis, c) in the “stonecracker’s nomansland” between the iliac crest and pelvic brim, and d) in the management of ureteral Steinstrasse when the debris did not pass spontaneously within eight weeks after insertion of a percutaneous nephrostomy (PCN)-tube. Of the stones treated, 29% were located above the iliac crest, 24% in the stonecracker’s nomansland, and 47% in the lower third of the ureter (Table 2).

Summary— This report documents our initial experience in the transurethral retrieval of ureteric stones using the rigid ureteroscope. Ten patients are included. Half of the stones were located in the lower one-third of the ureter and half in the upper two-thirds. They varied in size from 5 to 10 mm in diameter. Seven were successfully extracted at the first attempt using stone baskets under direct vision. Of the remaining 3, one was retrieved at a second ureteroscopy, one was fragmented and subsequently passed and one required percutaneous nephroscopy for its removal from the renal pelvis. It is concluded that transurethral ureteroscopy offers a safe alternative to both open ureterolithotomy and blind manipulation.

All cases involving ureteroscopy for the period of January 1, 1987, to January 1, 1988, were retrospectively reviewed. Of 97 total cases, 96 were performed with a 9.5 Fr. rigid ureteroscope. The reasons for ureteroscopy varied, including attempted basket extraction of a lower ureteral calculus (63%), evaluation of a non-negotiable ureter (13%), location of the calculus (8%), and retrieval of migrated double-J ureteral stent (5%). The treatment site was the lower ureter in 78% of cases.

Although the rigid ureteroscope was designed exclusively for the diagnosis and treatment of pathological conditions of the ureter, its smaller diameter and extended length allow for its increased use in endoscopic procedures that cannot be performed successfully with a cystoscope. The indications can be divided into 3 categories: 1) difficult ureteral catheterizations, 2) augmented bladders and diverticula, and 3) narrow, strictured urethras and bladder necks. Several cases from each category are presented to illustrate the expanded role of the rigid ureteroscope in daily urological practice.