Clinical Observation on the Role of Ureteroscopy

Park, Hyun Chul; Seo, Kie Seok; Rim, Joung Sik

Abstract

Today, Ureteroscopy is used for the diagnosis and treatment of various pathologies in the or urinary tract. From March 1987 to September 1996, we retrospectively evaluated our experiences with rigid ureteroscopy in 137 ureteral units in which therapeutic applications were 127 (92.7%) and diagnostic applications were 10 cases (7.3%). The causes ol therapeutic intervention were ureteral stones in 118 cases, upward migrated double J-stent in 6 cases, urethral foreign body (double J stent retention) in 2 cases and stenosis of ileoureteral anastomosis in 1 case. Success rate was 81.9% : 80.5% in the treatment of urethral stones, 100% in the treatment of urethral stenosis, 100% in the reposition or removal of retained catheter. Ureteroscopic stone extracton were performed in 77 cases (before introduction of ESWL) and in 41 cases (after introduction of ESWL). The latter was significantly decreased (78 of 288 or 32.4% versus 59 of 1588 or 3.7%). The success rate were 75.3% (58/77) before introduction of ESWL and 90.2% (37/41) after introduction of ESWL. The latter success rate was significantly increased. The causes of diagnostic intervention were upper tract bleeding in 2 cases, ureteral filling defect or delayed visualization at intravenous urography in 8 cases. The diagnostic results showed 1 case of ureteral transitional cell carcinoma, 1 case of ureteral stones, 1 case of urethral stricture, 3 cases of ureteral stones, 1 case of chronic ureteral inflammation and 3 cases of normal findings. Success rate was 90%. The frequency of diagnostic intervention increased from 1.3% for the 78 procedures done before introduction of ESWL to 15.3% for the 59 procedures done after introduction of ESWL. The minor complications (managed conservatively or with temporary stent drainage) occurred: flank pain in 35 cases (25.5%), gross hematuria in 10 cases (7.3%), high fever of over 38 degrees C in 5 cases (3.7%), ureteral perforations in 3 cases (2.2%) and urethral mucosal avulsion in 2 cases (1.5%). There were no major complications (all requiring an open surgery). In conclusion, after the introduction of ESWL the frequency of ureteroscpoic stone extraction decreased (p<0.05) and the frequency of diagnostic intervention increased (p<0.05). In the hands of experienced urologists the success rate of ureteroscopy increased.