[Rigid and flexible ureteroscopy. Apropos of 200 consecutive cases]

191 patients underwent a total of 200 ureteroscopies. Indications for these were as follows: ureter stones (172 cases); ureteral anomalies undiagnosed by other methods (20 cases); therapeutic ureteroscopy (8 cases). Stones: ureteroscopy for stones was carried out using either a rigid instrument (156 cases) or a flexible ureteroscope (16 cases). The localization of the stones was pelvic (123 cases), iliac (18 cases) or lumbar (10 cases). The stones were either removed directly using the basket under visual control (74/139 cases), or removed by ultrasonic/laser fragmentation (65/139 cases). As regards the rigid ureteroscope, success rates were 89% (139/156); 15 patients required additional therapy. Repeated ureteroscopic interventions always provided positive results. As concerns flexible ureteroscopy, we only had one positive result; 15 failure cases warranted repeated additional treatments. In three instances, failure with flexible ureteroscopy was corrected by using the rigid device during the same surgical period. We observed a single case of major complication in this series, i.e., a laterovesical urinoma which necessitated surgical drainage and was linked to the lack of ureteral drainage following ureteroscopy. Diagnostic ureteroscopic examinations: in 20 instances, ureteroscopy allowed to diagnose with precision the ureteral abnormality. No complication was reported following diagnostic ureteroscopy. Therapeutic ureteroscopy: such interventions were carried out to introduce a guide into the renal cavities (3 cases); to remove a double J stent, the lower extremity of which had moved up into the ureter (3 cases); or to carry out endoscopic ureterotomy (2 cases). Ureteroscopy is a safe and reliable method for the treatment of ureteral stones, and more particularly of stones localized in the distal part of the ureter.(ABSTRACT TRUNCATED AT 250 WORDS)