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The clinical evaluation of the recently introduced 8.5 F rigid ureteroscope is presented. This instrument is for diagnosis and surgical intervention within the ureter and renal pelvis and is specifically designed for use in small caliber adult and adolescent ureters. Twenty-four patients have been examined for diagnosis, removal of calculi, treatment of fistula, and resolution of prior iatrogenic injuries. Only one patient could not be examined due to fixation of the mid ureter.

The development of rigid and flexible ureteropyeloscopes has provided the means for direct visualization of the upper urinary collecting system. Each instrument has its own advantages and disadvantages. The combined use of these instruments extends the range of endoscopy throughout the intrarenal collecting system, permits irrigation and provides a working channel.

Flexible ureteropyeloscopy was performed on 59 patients with 2.7, 3.2 or 3.6 mm. endoscopes with a deflectable tip. Techniques for use of these flexible endoscopes are discussed in detail. The endoscope could be passed into the ureter in 58 patients and into the kidney in 52 (88 per cent). The entire collecting system was visualized in 23 of the most recent 29 patients (79 per cent). A diagnosis was achieved in all 23 patients with an intrarenal filling defect demonstrated radiographically. The source of gross hematuria alone could be defined in 9 of 17 patients. Surveillance for tumor was achieved in 5 of 5 patients and for residual calculus in 4 of 4. The endoscope was used to establish continuity successfully in 3 patients with an obstructed ureteropelvic junction. An instrument with a deflectable tip and some technique for irrigation are essential for intrarenal inspection and complete visualization of the ureter. This procedure is valuable in selected patients and it rapidly may become the technique of choice for the diagnosis of intrarenal filling defects. It also is of value in patients with benign, essential hematuria.