Long-Term Results of Transurethral Lithotripsy with the Rigid Ureteroscope: Injury of Intramural Ureter

Abstract

We treated 208 patients with ureteral calculi via transurethral lithotripsy using the rigid ureteroscope between March 1985 and April 1988. A total of 220 ureteroscopic procedures was performed in 217 ureters. Complete removal was achieved after 180 procedures (81.8%) and incomplete removal was achieved after 9 (4.1%). In 31 cases (14.1%) the stone could not be removed because of various reasons. Ureteral disruption was observed in 1 case (0.5%), which was treated successfully with reconstruction. Ureteral perforation occurred in 15 cases (6.8%) and was treated successfully except for 1 patient (0.5%) in whom ureteral stricture was observed requiring reconstruction. From long-term followup of sequential excretory urography and voiding cystography, mild stricture at the vesical end of the ureter was noted in 3 of 86 ureters (3.5%) and vesicoureteral reflux was noted in 7 of 73 (9.6%). These results indicate that the injury to the intramural ureter might arise from the passage of the ureteroscope resulting in stricture and vesicoureteral reflux.

Long-Term Experience with Transurethral Rigid Ureteroscopy as a Complementary Method to Extracorporeal Shockwave Lithotripsy

“…However there are certain limitations to ESWL therapy of ureter stones. Due to the physics of shock wave reflection, the treated stones ideally should be in a fluid environment [13,14], Especially big impact stones in the middle and upper ureter and stones in front of the os sacrum can be treated more effectively by urete roscopy [8,15], In our experience a combined therapy of ESWL and ureteroscopy or vice versa was necessary in 19.4%. Due to the rapid development and improvement of ESWL and ureteroscopy, surgical ureterotomy now is a rare excep tion.…”

Management and Follow-Up of Impacted Ureteral Stones

“…Long-term impaction is reported to produce ureteral tortuosity. An angiographic catheter may be placed to the stone's level and pass the guide wire through it, achieving less injury to the urothelium [7,8]. Ultrasound lithotripsy was our choice, based on the surgeons' experience in each use and the fact of less traumatic lithotripsy for the ureteral wall.…”

Iatrogenic ureteric injury: common medicolegal pitfalls

“…In 1989 Ono et al. [5] reported a series of 220 ureteroscopic procedures in 208 patients, carried out using the older 11.5 F rigid instruments. The authors embarked on an extensive follow‐up programme with IVU undertaken monthly for 6 months, then twice a year.…”