A New Alternative for Difficult Ureter in Adult Patients: No Need to Dilate Ureter via a Balloon or a Stent with the Aid of 4.5F Semirigid Ureteroscope (original) (raw)

2016, Journal of Endourology

Objective: To investigate the effectivity of 4.5 F Ultra-thin Ureteroscope (UT-URS) without any need for active or passive dilation in the treatment of adult patient population in whom ureteral orifices cannot be engaged using conventional URS. Method: Among a total of 512 adult patients who had undergone URS between April 2012, and November 2015 in our department for diagnostic or therapeutic purposes, 43 (8.4 %) patients required ureteral dilation because we couldn't engage ureteral orifice. In adult patients in whom we couldn't engage ureteral orifice with 7.5 F, and 8 F semirigid URS, we tried to complete the operation using 4.5F UT-URS without resorting to dilation. Age, and gender of the patients, indication for operation, stone size, and location, Operative times, laterality of stone(s), and stone-free rates, length of hospital stay, and complications were recorded. Result: Mean age of the patients was 34.5±11.2 (21-66 years) years. The patients had undergone operations for ureteral stone (n=39), unexplained hydronephrosis (n=2), and ureteral stenosis (n=2). Mean stone size was 8.2±2.3 (4-18) mm. Mean operative time was 64.2±13.5 minutes. Thirty seven of 39 patients complete stone-free rate (94.8 %) was achieved. Mean length of hospital stay was 8.9±5.8 hours. Conclusion: It has been demonstrated that in adult patient population in whom ureteral orifices cannot be engaged using conventional URS, ureteral access could be achieved with 4.5 F UT-URS without any need for dilation. At the same time, use of 4.5 F UT-URS resulted in an acceptable treatment success, and lower complication rates in most of these patients without the need for a second session.