Transurethral ultrasonic lithotripsy for ureteric stones under direct vision

With the development of the operating uretero-renoscope, and high frequency ultrasound generator, ureteric stones which otherwise would require open operative procedure can now be removed transurethrally with minimum morbidity and rapid recovery of patient. After preliminary cystoscopy, the ureteric orifice is dilated with flexible metal dilator or ureteric balloon dilator to size 15F. The rigid operating uretero-renoscope of 11F is then introduced and passed up to the stone. A 5F ultrasound probe is then passed through the uretero-renoscope to make contact with the stone. Stone disintegration with ultrasound is done under direct vision, and the fragments aspirated or removed with the help of forceps or Dormia basket. Of the first 70 patients done within 2 years from July 1984 to August 1986, 66 (94%) had their stones successfully removed by this procedure. It can be performed without radiological control and routine stenting of the ureter is not necessary. Serious complications included two perforation of the ureter and late development of ureteric strictures in another two patients. One patient had occlusion of the lower ureter requiring reimplantation.