Diagnostic and therapeutic applications of ureteroscopy in upper urinary tract filling defects

ABSTRACT

To evaluate diagnostic and therapeutic uses of ureteroscopy [URS] in upper urinary tract filling defects. Fourty patients with upper urinary tract filling defects underwent Ureterorenoscopy [URS], their age ranged from 38 to 83 years [Mean 68 yrs]. Clinical presentation included gross hematuria [20 cases], flank pain [13 cases], microscopic hematuria [5 case], and fever [2 cases]. Radiological studies [intravenous urography and/or retrograde urography], revealed filling defects in the renal pelvis [4 cases], upper ureter [16 cases], middle ureter [one cases], and lower ureter [19 cases]. Introduction of ureteroscopy was done without preliminary ureteral dilation in 60% of the cases. The procedure was completed in 38 cases and aborted in 2 cases because of inability to engage the ureter [one case], and perforation with extravasations [one case]. Diagnosis was established by direct endoscopic visualization in 26.3% of patients while 57.9% of patient's required additional biopsy. These procedures revealed that 34.2% of patients had malignant urothelial tumors, 18.4% had radiolucent stones. Benign ureteral polyps were found in 10.5% of patients, ureteritrs cystica in 7.9%, blood clots in 7.9% and papillary necrosis in 5.3% of patients. No abnormalities were detected in 6 patients [15.8%] by URS, further angiography's identified vascular anomaly in only one patient. In conclusion, URS proved to be of value in dealing with upper urinary tract filling defects. This procedure, whenever the lesion is accessible, can add in diagnosis and treatment of the underlying lesion causing a pelvic or ureteric filling defect. URS can disclose the nature of these lesions, and extensive surgery can be avoided