[Flexible ureteroscopy in upper urinary tract diseases]

Abstract

Study objective: Evaluation of active deflection flexible miniureterorenoscopes for diagnostic or therapeutic applications in the management of upper urinary tract diseases.

Material and method: The authors report a series of 111 consecutive patients undergoing a total of 137 flexible ureteroscopies for upper urinary tract disease between November 1997 and April 2001. The procedures were performed for diagnostic purposes (54 cases: 39%) or therapeutic purposes (83 cases; 61%). A successful procedure was defined as achievement of the objective defined when establishing the indication for ureteroscopy. The mean age of the patients was 51 +/- 15 years. The main diseases investigated or treated were stones (66%) and urothelial tumours (25%).

Results: The mean operating time was 42 +/- 22 min. The median length of postoperative hospital stay was 2 days (range: 0-27 days). 8% of patients did not require any postoperative ureteric drainage. 78% of the flexible ureteroscopies performed were successful. Complications were observed in 8% of cases, mainly macroscopic haematuria, including 3 major complications in the form of ureteric perforation. Serious intraoperative equipment damage was observed in 4% of cases.

Conclusion: Ureteroscopy with a flexible mini-ureteroscope is an effective, reproducible and minimally traumatic diagnostic and therapeutic technique for lesions situated above the iliac vessels. The use of various instruments, including the Holmium:Yag laser, should increase the range of possibilities of endoscopic techniques. The major limitation of active deflection flexible mini-ureterorenoscopes remains their fragility.