Developments in the ureteroscopes, techniques and accessories associated with laser lithotripsy

Two stages in the development of the technique of laser lithotripsy are described. In the first series, spanning 1985-1988, three consecutive groups of patients are compared. In the first 100 patients, 11.5-F ureteroscopes were used. Access on first retrograde attempt was successful in 73%; 3% developed strictures; the ureteric perforation rate was 7%; and 12% required nephrostomy drainage. These results contrast with those of the third group in this series, consisting of 200 patients using a miniaturised ureteroscope. Access on the first retrograde attempt was successful in 99%. There were no strictures, no perforations and no requirements for nephrostomy drainage. (The second group of 100 patients using a range of rigid ureteroscopes was intermediate in its complication rate: 2% developed strictures, the ureteric perforation rate was 3%, and 6% required nephrostomy drainage). In the second series, spanning 1989-1990, the procedures were performed by all grades of urologists using miniaturised endoscopes. An in-depth audit was performed and each patient was followed until completely clear of fragments. The stones were successfully accessed on the first attempt in 213 cases (89%). In group A (139 patients, no basket used) 32 renal units (23%) were cleared of stone fragments immediately following the procedure, rising to 78 units (56%) by 3 months and 99 units (71%) beyond 3 months follow-up. Some fragments remained in 40 renal units and were cleared by further ureteroscopy, ESWL or PCNL, with the exception of 1 patient who had small residual fragments despite ESWL for fragments flushed to the kidney.(ABSTRACT TRUNCATED AT 250 WORDS)