Résumé
Objectives: advances in endoscopic equipment have facilitated access to the proximal urinary tract and have expanded the indications for ureteroscopy. Our aim is to assess the safety and efficacy of ureteroscopy performed for proximal and distal ureteral calculi with the use of the lithoclast
Patients and Methods: eighty one patients underwent semi-rigid ureteroscopy for ureteral calculi at the Urology Department, Minia University hospital between January 2003 and February 2006 were included in this study. Thirty nine patients had distal ureteral calculi, 22 patients with mid ureteral calculi and 20 patients with proximal ureteral calculi. The lithoclast was the only available lithotripter in all the · patients
Results: complete fragmentation was achieved in all accessible calculi, all cases [39/ 39] 100% with distal, [18/22] 82% with mid and [16/20] 80% with upper ureteral calculi. The lithotripsy time was 8.5 minutes for stones< or =1 cm and 12 minutes for stones ranging from 1.1 to 1.8 cm. Completely fragmented stones cleared spontaneously within two weeks in 97.5% of cases and all patients were free of calculi one month after the procedure. Re-treatment with the lithoclast was required in four patients for large residual fragments. The mean hospital stay was 1.2 · days. Complications were minimal and were managed conservatively
Conclusions: ureteroscopic management of proximal and distal ureteral calculi is highly successful, and the difference in success rates has narrowed. Recently no greater risk is added to the patient for endoscopy of more proximal ureteral calculi. The addition of the flexible ureteroscope could make the success rate comparable. The lithoclast is a safe effective and reliable method of intracorporeal lithotripsy