Ureteroscopic injuries to the upper urinary tract.

Kaufman reported a severe ureteral injury following ureteroscopy in 1984. His commentary summarizes the important messages in this article well: The intent of this report is not to denegrate the splendid advances in nephroscopy and ureteroscopy, but rather to introduce a sobering message that the patient must be informed of the inherent risk of such procedures and that the urologist must be wary of the problems that might occur. Problems have been known ever since endoscopic instrumentation was first introduced, and every experienced urologist has had his share of problems associated with stone extraction and other endoscopic procedures. Traditional teaching in urology has been to eschew manipulation of stones in the upper two thirds of the ureter because the lumbar ureter is mobile and more easily damaged by instrumentation than the pelvic segment. Endoscopic visualization of stones in the upper ureter allowing accurate grasping of calculi would appear at first to provide an element of security heretofore unachievable, but urologists nonetheless should be mindful of the hazards of any type of stone extraction from the upper ureter. Urologists must be ready and equipped to handle emergencies associated with new instruments and techniques, and the patients must be apprised of the exigencies. "Caveat emptor" (buyer beware) could not be a more apt or timely maxim in our specialty. Ureteroscopy has greatly aided many patients, and a large number of urologists have integrated this procedure into their daily practices.(ABSTRACT TRUNCATED AT 250 WORDS)