Ureteroscopic manipulations in bilharzial ureter: difficulties and precautions

Ninty two bilharzial patients were subjected to different ureteroscopic manipulations for primary ureteric stones [5 7 patients], ureteric stricture with secondary stones [13 patients] and ureteric stricture [22 patients]. Difficulties of the technique included: failure to identify the ureteric orifice, shredding and cracking of the mucosa during dilatation, upward migration of stones in dilated ureters, restricturing after dilation and vesico-ureteral reflux. Different precautions had been used to avoid these difficulties. He concluded that although bilharzial affection of the ureter is not a contra-indication for ureteroscopy yet it imposes certain difficulties upon the procedure and must be cautiously handled

Ureteral stone manipulation: which modality is suitable for a given situation

Four different modalities were tried for ureteral stones extraction or fragmentation in 228 patients harbouring single or multiple ureteral stones at different levels. Mechanical extraction was tried in 46 patients, ultrasonic disintegration in 80 patients, lasertripsy in 82 patients while ESWL was tried in 20 patients with ureteral calculi. Mechanical extraction was found to be suitable for stones less than 1 cm in healthy ureter in adult patients while ultrasonic disintegration was successfully tried in relatively big stones with rough surface and dilatable middle and lower third in adult patients. Lasertripsy had been successfully used to fragment stones in bilharzial ureters, impacted stones and in children. ESWL was found to be successful both in upper, lower and intramural calculi