Use of semirigid ureteroscopes for treatment of ureteral calculi

(Background) The objective of this study is to evaluate the efficacy of ureteroscopic lithotripsy as the treatment of ureteral stoens in the recent era by comparing the result using a semirigid ureteroscope with the result using a conventional ureteroscope. (Methods) Between 1991 and 1994, 136 patients with ureteral calculi underwent transurethral ureteroscopic lithotripsy in our hospital. From July 1991 to March 1993, 14F rigid ureteroscope with the rod lens system was used for 82 patients (group 1), whereas from April 1993 to July 1994 either a 9.5F or 7F semirigid fiberoptic ureteroscope was used for 54 patients (group 2). Insertion of uteroscopes was performed under continuous irrigation of saline without mechanical dilation of the ureteral orifice in both groups. (Results) The rates of complete removal of stone at the first trial were 56.1% in group 1 and 72.2% in group 2 with the overall complete removal rate of 62.5%. The complete removal rates of stones in the upper, middle and lower ureters were 18.2%, 54.8% and 72.4% in group 1 and 14, 3%, 72.7% and 88.0% in group 2, respectively. The major reason for unsuccessful treatments was upward migration of stones during the procedure. As intraoperative complications, ureteral disruption occurred in 1 case in group 1, and ureteral perforation in 5 patients in group 1 (6.1%) and 2 in group 2 (3.8%). Acute bacterial infection with prolonged fever was observed in 3 patients in group 1 and in none in group 2. (Conclusion) From these results, the new semirigid ureterscope with fiberoptic imaging bundles made the transurethral lithotripsy a safer and more efficient procedure for the treatment of ureteral calculi especially those in the lower ureters.