Ureteroscopy in the treatment of ureteral stones: over 10 years' experience.

OBJECTIVE

Rapid development of endourology and the invention of more and more advanced ureteroscopes and other instruments used in ureteral lithotripsy have made the traditional methods of treatment become very rare.

METHODS

We present our experience in ureteral lithotripsy resulting from 1,982 ureteroscopy (URS) procedures, performed because of ureteral stones. Before URS, percutaneous nephrostomy tube (PCNT) was created in 264 (16.7%) cases. We also present our own technique, called the 'Jeromin maneuver', which involves pressing the abdominal wall by the assistant's hand, facilitating URS in difficult cases.

RESULTS

Good results after the first URS procedure of removing ureteral stones were obtained in 1, 364 (86.6%) patients out of 1,575. In the remaining 211 (13.4%) cases, URS was performed two or more times. The overall failure rate was 3.6%. In the vast majority of cases, URS procedures were performed without dilatation of the ureteral orifice and splinting. The most important complications of URS were: perforation of the ureteral wall with periureteral leak which necessitated surgery (4 patients), ureteral stenosis which necessitated endoscopic reparation (4 patients) and stenosis of the ureteral orifice which necessitated endoscopic reparation in 2 patients.

CONCLUSIONS

Routine dilatation of the ureteral orifice before the URS procedure and splinting with a D-J catheter are unnecessary; in case of a narrow ureter and very large prostatic adenoma, URS should not be attempted, because of the high risk of serious damage of the ureter. URS is a safe procedure but requires a highly experienced urologist.