Large benign prostatic hyperplasia means impossible ureteroscopy: Myth or reality?

Objective: We intended to ascertain the true role played by large-size pros tatic glands with BPH in impeding ureteroscopy; since no such impediment wa s experienced by the authors, we then listed the most frequent obstacles to ureteroscopy, contrary to what is commonly reported in literature. Materials and Methods: Endourological reports on a series of 2,147 diagnost ic or therapeutic ureteroscopies were examined, together with the patients' clinical records. Male patients accounted for 1,288 cases. In 45 cases, th e operate rs found the prostate so enlarged as to be worthy of note. In 9 o f these cases, the procedure was performed bilaterally; thus, a total of 54 ureteroscopies was undertaken in patients with enlarged prostates or large median lobes. Results: None of the surgical reports indicated that the ureteroscopic proc edure was hindered by an enlarged prostate. On the other hand, the most fre quent causes preventing ureteroscopy are, for both male and female patients , some types of tumor: uterine, ovarian, ureteral, bowel, bladder and prost ate cancer, and inflammation. Conclusions: Benign prostatic hypertrophy (BPH) is not of itself an impedim ent to ureteroscopy when it is performed by an expert operator equipped wit h suitable instruments. On the other hand, tumours of the female reproducti ve system, as well as bladder and prostate tumours and serious inflammation s and infections may make the procedure impossible or cause serious problem s during its performance, at times requiring combined antegrade and retrogr ade manoeuvrings. At the root of this obstacle lies neoplastic or inflammat ory infiltration and stiffening which attaches itself to the organs and har dens their connections. In the case of BPH, we do not find infiltration, bu t only a dislocation, which can be compensated by means of a few technical stratagems. Some intersting expedients in the incannulation of difficult me atuses were already suggested in 1914 by Heitz-Boyer and Marion. Copyright (C) 2000 S. Karger AG, Basel.