Ureteral dilation using a tapered dilator: a cost-effective approach

Acute Dilatation of Intramural Ureter for Ureteroscopy: Railway Technique

PURPOSE

To assess the safety and efficacy of acute dilatation of THE intramural ureter for ureteroscopy by the railway technique.

PATIENTS AND METHODS

Between January 2000 and December 2004, 400 consecutive ureteroscopic procedures were performed, among which 15 male and 5 female patients (5%) with an average age of 40 years (range 25-65 years) underwent acute dilatation of the intramural ureter by the railway technique A guidewire is placed into the ureter, and a 3F ureteral catheter is passed through the working channel of the ureteroscope (8.5F-10F) for 3 to 5 cm into the ureter. The ureteroscope is rotated so that it lies between the guidewire (outside) and the ureteral catheter (inside) and advanced between the guidewire and the ureteral catheter like riding over a railway. Postoperatively, no double-J stent was used. The mean follow-up was 25 months (range 6-60 months). An intravenous urogram and voiding cyctourethrography were obtained at 3 months, and ultrasonography was performed every 6 months in the first year and every 2 years after ureteroscopy in all 20 patients.

RESULTS

Ureteral access was achieved with the railway technique in all 20 patients. Perforation or intramural false passage of the ureter did not appear. Follow-up imaging showed no distal-ureteral stricture or vesicoureteral reflux.

CONCLUSIONS

Acute dilatation of the intramural ureter by the railway technique is cost effective, safe, easy, rapid, and predictable. This time-saving technique often removes the need for balloon dilatation of the distal ureter.

Routine ureteral dilatation is not necessary for ureteroscopy

PURPOSE

To present our experience in ureteroscopic lithotripsy and stone extraction without ureteral dilatation.

PATIENTS AND METHODS

A total of 134 consecutive patients (80 male and 54 female), with a mean age of 36.4 (18-65) years underwent ureteroscopic stone removal. The stones were located in the lower, middle, and upper parts of the ureter in 92, 18 and 24 patients and the mean stone diameters were 9.2 (6-15) mm, 10.5 (8-15) mm and 8.8 (8-10) mm, respectively. A semirigid ureteroscope 8 F in size was used without any ureteral dilatation. The stones were fragmented by a pneumatic lithotripter in the ureter and the fragments were removed by a basket catheter or stone forceps. All patients were re-evaluated with a plain film on postoperative first day and with intravenous urography (IVU) at 3 months. Residual fragments bigger than 3 mm were accepted as treatment failure.

RESULTS

The mean operation time was 44 (20-120) minutes. After the operation, the stone-free rate was 89/92 (97%) for lower, 15/18 (83%) middle and 18/24 (75%) upper ureteral stones, respectively. Double J catheter replacement was needed in 13 patients due to impacted stone and/or failed procedure. Ureteral perforation did not occur in any patient. Patients were discharched from hospital within 6-24 hours. No ureteral stricture was encountered during the follow-up period.

CONCLUSION

Our experience suggests that ureteroscopic interventions could be easily performed for all parts of ureter without previous dilatation of the ureter.