The Semi-rigid Ureteroscope as a Sole Dilator for Ureteroscopy

Introduction To determine the efficacy and safety of using the semi-rigid ureteroscope as the only ureteral dilator for primary ureteroscopy URS in the treatment of renal stones. Materials and Methods A retrospective review of primary URS for renal stone disease was performed on consecutive patients treated by a single provider CLA from 2013 to 2017. Utilizing wire placement under fluoroscopic guidance and direct visual ureteroscopic dilation with a semi-rigid ureteroscope, primary outcome was successful completion of stone treatment. In addition, perioperative safety was evaluated. Results A total of 126 consecutive cases of primary URS using the semi-rigid ureteroscope as the only ureteral dilator were attempted for renal stone treatment. The renal stones were treated in 124 98.4 percent patients without other forms of active ureteral dilation. Two 1.6 percent patients required ureteral stent placement for passive dilation despite attempted other dilating techniques. No intraoperative ureteral perforations were identified. Post-operative radiographic follow up was available for 67 percent patients with a 91 percent stone free rate and no hydronephrosis or ureteral strictures were detected. Conclusion Utilizing direct visual semi-rigid ureteroscopic dilation with a semi-ridged ureteroscope prior to flexible ureteroscopy leads to successful primary ureteroscopy for renal stone treatment in most patients. This technique is an effective, safe and possibly cost-effective method of obtaining ureteral access to facilitate primary URS for renal stone treatment.