Ureteroscopy: the initial experience.

A prospective study of our first 81 cases of ureteroscopy using extended length rigid endoscopes was performed. Of 55 stone manipulations attempted in 51 patients by 6 endoscopists 38 (69 per cent) were successful. Analyzed sequentially, removal was successful in 12 of 23 attempts (52 per cent) among the initial 40 patients and in 26 of 32 (81 per cent) among the subsequent 41 patients. Of 11 calculi larger than 1 cm. and of 23 positioned above the iliac vessels 7 (64 per cent) and 11 (48 per cent), respectively, were removed successfully. Disimpaction by ureteroscopic manipulation combined with extracorporeal shock wave lithotripsy was successful in 4 cases of upper ureteral calculi not treatable by extracorporeal shock wave lithotripsy alone. Diagnostic and therapeutic uses of the ureteroscope in addition to treatment of ureteral calculi have included the delineation of ureteral filling defects (9 patients), fulguration of known low grade tumors (4) and dilation of ureteral strictures (5). In 10 patients information was obtained endoscopically that was not possible by standard diagnostic techniques. The direct visual approach to the ureter has distinct advantages over blind ureteral instrumentation.