URETERAL STONE SURGERY IN PRACTICE

Summary— From 1983 to 1986 140 patients underwent surgery for ureteric calculus. In approximately 30%“blind” basket extraction was considered appropriate and continued to be effective. Increasing expertise with the rigid ureterorenoscope led to a considerable reduction in open ureterolithotomy (15% in 1985–86), the majority following failed ureteroscopic extraction. In the same year both “blind” basket extraction and ureteroscopy were successful in 82 and 86% of attempts respectively. Electrohydraulic and ultrasonic lithotripsy were used in 12 patients to reduce large impacted calculi. The commonest complication of ureteroscopic stone surgery was perforation; this occurred in 14% of cases, though it was usually trivial and near the vesicoureteric junction. Perforations higher in the ureter tended to follow endoscopic lithotripsy and were often associated with urinary extravasation. Extra‐ureteric stone fragments were also occasionally observed in such cases. There were no serious sequelae, although the in‐patient stay was prolonged beyond the 48 h customary for uncomplicated extraction. The results suggest that ureteroscopic stone extraction, which can be conveniently introduced into urological practice, should become a standard endoscopic procedure. Copyright © 1987, Wiley Blackwell. All rights reserved