[Flexible ureteroscopic approach in upper urinary tract pathology].

In many prestigious centers, flexible ureteroscopy (FU) has rapidly evolved into a routine application. Our goal was to evaluate the efficiency of FU in upper urinary tract pathology. Between October 2002 and January 2006, 106 patients underwent FU for upper urinary tract pathology: retrograde (23 for diagnosis, 7 for follow up after conservative treatment of upper urinary tract TCC and 67 therapeutical) and antegrade (9 cases) procedures. Therapeutical retrograde FU was indicated for: stones (59 cases), symptomatic pyelocaliceal diverticulum with intra-diverticular lithiasis (7 cases) and pyelocaliceal TCC (3 cases). Antegrade FU was performed 9 cases with ureteral or uretero-enteric strictures. In all cases we used a 7.5F Storz flexible ureteroscope. As energy sources we used Nd:YAG laser and an electrohydraulic lithotripsy device. Diagnosis retrograde FU identified upper urinary tract abnormalities in 95.7%. In the patients with lithiasis, the procedure was considered a success if complete stone clearance or lithotripsy in fragments smaller than 3 mm was achieved. The over-all success rate in these cases was 72.7%. In 57.1% with pyelocaliceal diverticula laser incision of the narrow isthmus was practiced, followed by electrohydraulic lithotripsy of the stones. All the 4 cases were stone-free at the end of the procedure. In 66.7% of patient with TCC, evaluation at 6 and 12 and 18 months demonstrated no tumoral recurrence. In 77.8% patients with ureteral or uretero-enteric strictures who underwent antegrade FU, postoperative evaluation at 6 and 18 months showed good results. No intra- or postoperative complications were described. According to our experience, FU could be an efficient method in upper urinary tract pathology diagnosis and treatment in selected cases. FU has opened a vista of endless limits in upper urinary tract endoscopy.