Ureteroscopy (URS)

The ureteroscopy is a method of endoscopic control of the ureter from the ureteral orifice until the renal pelvis.It can be made with a rigid, semi-rigid (semi rigid) and flexible uretoscopy, with the last to penetrate within the kidney, and the possibility of kidney stones or pelvic tumors with laser.

Indications for ureteroscopy:

• ureteral Stones

• Ureteral obstruction with concomitant hydronephrosis

• Aktinodiavatos stone

• Overweight patients > 135 kg, vrachysomoi patients <100cm

• Gritty ureter during pregnancy

• Failed ESWL, ureteric lithiasis chain after ESWL or PCNL

Contraindications ureteroscopy:

• Disorders of coagulation mechanism

• Urinary tract infection untreated

Complications of ureteroscopy:

• Pain from 3.5 to 9 %

• Ureteral Perforation 1-4.5 %

• Urinary 1%

• Fever 2-6%

• Hematuria 0.4-2 %

• Ureteral stricture 0.5-1.5 % (as a long-term complication) and

• Full ruptured ureter < 0.6 %, which is the most serious complication

The systems that use for fragmentation of the stone during ureteroscopy are:

1. Electra hydraulics

With this fragmentation of the stone becomes with shockwave that generated by an electric discharge in the aquatic environment by evaporation of water.

It requires placement of the electrode very close to the stone with an increased risk of mucosal injury and ureteral perforation. With this method, the decomposition rate of the stone reaches 90-93 %.

2. Laser (Holmium: YAG laser)

Here the fragmentation of the stone is achieved by releasing electrons and creating “bubble” disruption of which causes a shock wave. The electrode is placed in contact with the stone and the stone disintegration rate reaches 95-98 %.

3. Ballistic Lithotripter 

It works with vibration metal part through compressed air and requires contact with the stone. The success rate is less than other methods and amounts to 73-96 %.