Role of flexible mini-ureteroscopes in upper urinary tract disease.

Introduction : The management of upper urinary tract disease has been impro ved by miniaturization of endoscopes. Our objective was to assess the value of flexible mini-ureteroscopes for the diagnosis and treatment of upper ur inary tract lesions. Patients and Methods : 33 consecutive patients (mean age: 49+/-16 years; 23 men) underwent first-line flexible ureteroscopy for upper urinary tract di sease, consisting of stones: 21, filling defect: 6, stenosis: 3, haematuria : 2, positive cytology: I and situated int the kidney + renal pelvis: 14 or ureter: 19. The 21 stones were situated in: the calyx: 5, renal pelvis: I, lumbar ureter: 8, iliac ureter: 3, pelvic ureter: 4. Their mean dimensions were 9.7+/-4 x 5.3+/-2.3 mm. Previous treatment had failed for 13 stones. There 7.5 F flexible ureteroscopes of various brands were used. Results :All patients were operated under general anaesthesia. Antegrade ur eteroscopy was performed in 2 patients. Advancement of the ureteroscope was considered to be difficult in 5 cases, including the 2 antegrade cases. 13 stones were fragmented by hydroelectric waves. The mean duration of ureter oscopy was 40+/-15 min. The mean hospital stay was 2.8+/-1 days. There was no intraoperative or perioperative morbidity. Ureteroscopy was considered t o be successful in 27 cases (82%) and a failure in 6 cases: fragmentation: 3 and progression: 3. Fifteen patients were reviewed after more than one mo nth (3+/-2 months) with no morbidity. Conclusion : Ureteroscopy with flexible mini-ureteroscopes is an effective, reproducible and minimally traumatic diagnostic and therapeutic technique. It is particularly useful for lesions situated above the iliac vessels and is indicated for diagnostic assessment and stones but also upper tract mal formations and strictures.