Endoscopic surgery of the upper urinary tract.

Endoscopic surgery of the upper urinary tract had made rapid advances in the past three years. At our institution endoscopic removal of upper urinary tract stones had almost replaced open surgical procedure which is now done in only about 2% of the surgical stones seen. Over 1,000 cases of percutaneous stone removal had been done and for renal and uretero-pelvic junction stones our success rate is 96% while ureteral stones are less amenable to removal and the success rate is about 86%. Complications include procedure bleeding, entravasation of irrigating fluids, perforation of the collecting system and sepsis. All these are rare and can be managed conservatively. A more serious complication is that of AV malformation in six cases out of 1,000 patients due to damage to renal vessels. Fortunately this can be treated with arteriography and embolisation. Retained fragment rate is about 6%, these are, however, non-surgical fragments. Percutaneous techniques may also be used for diagnostic inspection of the collecting system and for treatment of certain cases of uretero-pelvic junction obstruction. Instruments are now also available for transurethral uretero-renoscopy, it is generally possible to manipulate and remove many ureteral stones under direct vision.