Retrograde ureterorenoscopy in the management of ureteral calculi

Endourologic techniques have revolutionized the line of treatment of ureteral stones. The scope of open ureterolithotomy has been narrowed and the contraindications for endoscopic manipulations of ureteric stones became limited. Using the rigid ureterorenoscope (URS) after endoscopic dilatation of the intramural ureter, we have manipulated 45 ureteral stones located at different levels, 33 in the lower ureter (distal ureter), 7 in the middle third and 5 in the upper third (proximal ureter). Successful manipulations occurred in 32 stones (in 21 by retrieval and in 11 by disintegration using ultrasonic lithotripsy). Failures were due to upward dislodgement of the stone in 5 cases, to grasp or disintegrate the stone in 2, perforation of the ureter in 2, bleeding from the ureteral wall in 2 cases, to reintroduce guidewire in the ureter and to non-passable stricture below the stone in 1 case each. Delayed complications occurred in 4 patients. Two patients developed ureteral stricture, one suffered vesicoureteral reflux and one ultimately had urethral stricture.