OBJECTIVE To review our 15‐year experience with ureteroscopic treatment of distal ureteric calculi and to determine the impact of improved technology and techniques on the efficacy, success and complications of the procedure. PATIENTS AND METHODS We retrospectively reviewed the medical records of 4512 patients who underwent 5133 ureteroscopic procedures for the treatment of distal ureteric calculi at our institution from January 1991 to December 2005. The patient and stone characteristics, treatment variables and clinical outcomes were assessed. Factors such as type of ureteroscope, procedure duration, procedure success, complication rate and hospital stay were evaluated. Data obtained from a cohort of patients that underwent the procedure from 1991 to 1995 (group 1) were statistical compared with those obtained from a cohort of patients from 1996 to 2005 (group 2). Logistic regression analysis was used to identify associated factors with the major complications of ureteroscopy. RESULTS Overall, the stone‐free rate after the procedure was 94.6%, the mean (sd; range) operative duration was 43 (15.0; 25–120) min, the intraoperative complication rate was 6.67%, the postoperative complication rate was 9.9%, and the mean (sd) hospital stay was 1.7 (1.1) days. The clinical and radiological follow‐up (mean 36.8 months) for 71.3% of eligible patients detected only 12 ureteric strictures (0.23%). On comparing group 1 with group 2, the overall success of ureteroscopic stone extraction improved from 85.7% to 97.3% (P < 0.001), significant ureteric perforation decreased from 3.3% to 0.5% (P = 0.05), ureteric avulsion decreased from 1.3 to 0.1% (P < 0.05), ureteric stricture decreased from 0.7% to 0.1% (P < 0.007), the mean (sd) procedure time significantly decreased from 75 (42.9) min to 36.5 (12.5) min (P < 0.001), and the mean hospital stay significantly decreased from 2.5 (1.6) days to 0.5 (1.2) days, with a trend toward outpatient treatment. Logistic regression analysis showed a significant association of the major ureteroscopic complications with increased operative duration, type of ureteroscope used, stone impaction, stone size and surgeon experience. CONCLUSION The present series shows the high success rate, with minor complications, that can be achieved with ureteroscopic treatment of distal ureteric calculi. Improvements in ureteroscope design, accessories, technique and experience have led to a significant increase in the success rate and decrease in the complication rate.

with conventional US followed by DUS in both kidneys. RESULTSThe mean period of gestation at presentation was 25.5 weeks. Stones were found in the right side in 11 patients (73%), in the left in three (20%) while no stone was found in the remaining patient (7%). There was a significantly higher mean resistive index in all 15 obstructed kidneys than in the contralateral normal kidneys. RU was used in all patients, with removal of the stones and fixation of JJ stent. All patients improved after the procedure and completed pregnancy safely up to full-term, except for premature labour in one patient. CONCLUSIONDUS and RU are efficient for the diagnosis and treatment of symptomatic ureteric stones during pregnancy.

The aim of the study was to evaluate endourological techniques in the management of iatrogenic ureterovaginal fistula. Seventeen patients referred to us after gynecologic surgery were diagnosed as having iatrogenic ureterovaginal fistula. First, retrograde double-J stenting was tried. If this failed, percutaneous nephrostomy using an antegrade double-J stent was performed. If this also failed, open surgical repair was performed. The retrograde double-J stent bypassed the fistula in 2 patients (11.8%). Percutaneous nephrostomy was performed in the remaining 15. The antegrade double-J stent bypassed the fistula in another 2 of these patients (11.8%). Open surgical repair was performed in the remaining 13 patients (67.5%) (direct ureteroneocystostomy) with nipple valve in 11 patients and Boari flap with psoas hitch in 2 patients). Of all patients, 2 had ureteral stricture, one after antegrade double-J stenting and the other after open repair. It was concluded that early intervention is recommended in the treatment of iatrogenic uretrovaginal fistula, causing minimal morbidity and discomfort, and being less expensive.

This study evaluated the use of traditional polypropylene mesh, used in hernias repair, as a sling in the treatment of female stress urinary incontinence (SUI). Forty patients diagnosed with SUI underwent transobturator sling fashioned from the ordinary polypropylene mesh (vypro II). Each lateral end of the tape is secured by a zero prolene suture. The procedure was then done outside-in, and the patients were followed up. The mean operative time was 40-60 min when the procedure was performed alone or accompanied with associated pelvic floor repair. Thirty-five patients (87.5%) were cured, and two patients (5%) significantly improved, but the procedure failed in three patients (7.5%), and the slings were removed because of vaginal erosion. Polypropylene mesh transobturator sling is an easy and cheap method for the treatment of female SUI with a high success rate.