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Ureteroscopy (URS): an effective interventional and diagnostic modality
1Department of Urological Surgery and Transplantation, Jinnah Postgraduate Medical Center, Karachi.
Objective:
To study the effectiveness and complications of the use of ureteroscope in the management of ureteral calculi and as diagnostic modality for ureteric strictures and hydroureter.
Patients And Method:
URS was carried out in 125 consecutive patients. Technical failure to negotiate the ureteric orifice was observed in 10 (8%) patients. Three of them had passive dilatation with ureteric catheter for 48 hours, while in 7, the failures were due to inability to traverse the ureter. This study will thus review 118 patients, 87 males (73.7%) and 31 females (26.3%) with a mean age 38 years +/- 12 years during 24 months. All the ureteroscopies were performed with a 8 FG rigid ureteroscope under G.A. Swiss (pneumatic) lithoclast was used for lithoripsy. Of the 118 patients, 98 calculi were treated. Five of these patients had associated ureteric strictures. Twenty patients underwent ureterorenoscopy for diagnostic purposes. Ten of them had ureteric strictures and in 10 patients dilated ureters with no luminal obstruction was found.
Results:
Four (4%) of the stones were located in the upper, 13 (13.2%) in middle and 81 (82.6%) in the lower ureter. The size of the stones treated ranged between 6-22 mm. Clearance of stones within 48 hours and 15 days was observed in 66.3% and 93.8% respectively. Only 6.1% of the patients had failure to clear calculus after 30 days and repeat procedures were required. Four of the patients with ureteric strictures had ureteroneocystostomy while in 6 endoscopic dilatation was done. Thirty one and 10 patients had fever upto 38.5 degrees C and more than 38.5 degrees C respectively. Percutaneous Nephrostomy (PCN) placement was required in 2 patients and stripping of mucosa occurred in 1 patient. Mild hematuira was observed in 46 (38.9%) patients. Only 2.5% had moderate degree of hematuria after the procedure.
Conclusion:
Considering the result from this study we suggest that URS is an effective interventional and diagnostic modality for ureteric diseases with a low complication rate.