URETEROSCOPY IN THE TREATMENT OF URETERAL STONES - OVER 10 YEARS EXPERIENCE

Objective: Rapid development of endourology and the invention of more and more advanced ureteroscopes and other instruments used in ureteral lithotripsy have made the traditional methods of treatment become ver y rare. Methods: We present our experience in ureteral lithotripsy res ulting from 1,982 ureteroscopy (URS) procedures, performed because of ureteral stones. Before URS, percutaneous nephrostomy tube (PCNT) was created in 264 (16.7%) cases. We also present our own technique, calle d the 'Jeromin maneuver', which involves pressing the abdominal wall b y the assistant's hand, facilitating URS in difficult cases. Results: Good results after the first URS procedure of removing ureteral stones were obtained in 1,364 (86.6%) patients out of 1,575. In the remainin g 211 (13.4%) cases, URS was performed two or more times. The overall failure rate was 3.6%. In the vast majority of cases, URS procedures w ere performed without dilatation of the ureteral orifice and splinting . The most important complications of URS were: perforation of the ure teral wall with periureteral leak which necessitated surgery (4 patien ts), ureteral stenosis which necessitated endoscopic reparation (4 pat ients) and stenosis of the ureteral orifice which necessitated endosco pic reparation in 2 patients. Conclusions: Routine dilatation of the u reteral orifice before the URS procedure and splinting with a D-J cath eter are unnecessary; in case of a narrow ureter and very large prosta tic adenoma, URS should not be attempted, because of the high risk of serious damage of the ureter. URS is a safe procedure but requires a h ighly experienced urologist.