The Experience of Ureterorenoscopic Lithotripsy with Insertion of Ureterorenoscope between Two Safety Guide Wires Serving as an Access Port

Lee, Kyung Won; Lee, Tchun Yong; Woo, Young Nam

Abstract

PURPOSE: Although ureterorenoscopic lithotripsy (URSL) is highly successful in urinary calculous disease, there are still several problems associated with the procedure, such as the difficulty in learning the procedure and the relatively high risk of ureteral injury. We performed an URSL, with the insertion of an ureterorenoscope between two safety guide wires, which served as an access port, without the need for ureteral dilatation (new URSL), and evaluated the usefulness and efficacy of this method by a comparison of our results with those of a series of conventional URSL.
MATERIALS AND METHODS
Sixty-six ureteral stones (63 cases) were treated by a new URSL procedure. At the beginning of the procedure, two safety guide wires were inserted into the ureter. The ureterorenoscope was then inserted into the ureter between the safety guide wires. The outcomes were assessed, and compared to 140 cases of conventional URSL performed by the same operator.
RESULTS
The overall success rate of the new URSL procedure was 98%. The mean operation time and postoperative hospital stay were 33 minutes (10-70min) and 1.4 days (1-6 day), respectively. Complications were observed in 5 cases (7.5%), and included, an ureteral perforation in 1 case, mild to moderate ureteral injury in 2, a gross hematuria in 1 (>48 hr) and flank pain in another.
CONCLUSIONS
Based on our experience, the new URSL has several merits compared to the conventional procedure, such as no need for ureteral dilatation, easiness of the insertion of the ureterorenoscope into the ureter, prevention of upward migration of the stone during the procedure, and the better visual operation field. The new URSL procedure is relatively easy to perform, with few complications, and would, therefore, be an alternative to conventional URSL.