Transurethral ureterolithotripsy with rigid ureteroscope--efficacy of balloon dilation of ureteral orifice and intramural ureter

Abstract

In order to minimize the late complications of transurethral ureterolithotripsy with a rigid ureteroscope such as distal ureteral stricture or vesicoureteral reflux, we have performed a balloon dilation of the ureteral orifice and the intramural ureter prior to insertion of a rigid ureteroscope in 62 cases with ureteral calculi between October 1986 and December 1991. A 7F balloon dilator (Bard Co. USA) was cystoscopically inserted into the ureter over a 0.038 inches Radifocus guide wire (Terumo Co., Japan) and then, a balloon was inflated to 15F size with saline using a 10 ml disposal syringe. Thereafter, an 11.5F rigid ureteroscope (Wolf Co., Germany) was inserted instead of a balloon dilator. The stone was disintegrated and removed by ultrasonic lithotripter, electrohydraulic lithotripter and/or basket forceps. The stone was removed completely in 45 cases (72.6%) and incompletely in 10 (16.1%). In 7 cases (11.3%), the stone removal was failed. Long-term follow up with an excretory urography obtained at 6 months or later in 31 cases showed no distal ureteral stricture. Voiding cystography was performed in 33 cases at a mean 2.8 months postoperatively and no vesicoureteral reflux was observed. In control group, 309 cases were treated with transurethral ureterolithotripsy without dilation of the ureteral orifice and the intramural ureter between the same period. A complete removal was achieved in 262 cases (84.8%) and an incomplete removal in 16 (5.2%). 31 (10%) was failed. Distal ureteral stricture due to this procedure was found in 3 cases (2.1%) in 141 long term followed up cases.(ABSTRACT TRUNCATED AT 250 WORDS)