Purpose: We compared a current cohort of patients who underwent ureter
oscopy to a cohort from the early 1980s to determine changes in succes
s, indications and long-term complications of the procedure. Materials
and Methods: A chart review was performed of 194 patients who underwe
nt 209 ureteroscopic procedures at our institution during 1992. This g
roup was then statistically compared to 317 patients who underwent 346
ureteroscopies between 1982 and 1985. Results: The current indication
s for ureteroscopy were calculus extraction (67% of the cases), diagno
sis (28%) and stent manipulation (5%). These indications differed from
those of the early series, in which 84% of all ureteroscopies were pe
rformed for calculus extraction and 16% for diagnosis. Overall uretero
scopic success rate increased from 86 to 96% (p < 0.001). Success of s
tone extraction improved from 89 to 95% (p = 0.08, distal success rate
95 to 97% and proximal success rate 72 to 77%). Success of diagnostic
inspections increased from 73 to 98% (p < 0.001). In the early series
failure was usually due to inability to traverse the ureter (54% of t
he cases), while currently failure is due almost exclusively to impass
able ureteral strictures (63%). The overall complication rate decrease
d from 20 to 12% (p = 0.01) and the rate of significant complications
decreased from 6.6 to 1.5% (p < 0.05). Clinical followup (mean 36 mont
hs) for all patients and radiological followup (mean 9.8 months) for 6
7% of eligible patients detected only 1 ureteral stricture. The remain
ing patients were asymptomatic after the ureteroscopic procedure. Conc
lusions: Improvements in ureteroscope design, accessories and techniqu
e have led to a significant increase in the success of diagnostic and
therapeutic ureteroscopy while decreasing morbidity. Outpatient ureter
oscopic stone extraction, particularly for distal ureteral calculi, is
almost uniformly successful with low morbidity. The long-term complic
ation rate of ureteroscopy is 0.5%.