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Year : 1993  |  Volume : 9  |  Issue : 1  |  Page : 14-16

Staged ureteroscopy : a safe and economical option for difficult lower Ureteral Calculi

Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow

Correspondence Address:
D Dalela
Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow

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Source of Support: None, Conflict of Interest: None

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Prolonged impaction and large bulk continue to pose challenges in ureteroscopic retrieval of lower ureteral calculi. The salvage options of adjunct ESWL or immediate ureterolithotomy have been unsatisfactory in our experience. We have, instead, treated 13 such cases with staged ureteroscopy. In the first stage, a splint (DJ stent/ureteric catheter/guide wire) was left in the ureter, in 7 cases bypassing the calculus, and in 6 left just below the calculus. After an intervening period of 3 days to 3weeks repeat ureteroscopy was successful in clearing the calculi in all the cases, the average post procedure hospital stay for the staged ureteroscopy has been lesser than that for ureterolithotomy and there is no added morbidity. Following the intervening period of ureteric intubation, the ureter below the calculus becomes straight and dilated facilitating the approach to the calculus. Dilatation of the ureteric meatus with resolution of the edema close to the impacted calculus also make the second procedure easy to perform. This approach is especially suitable for the developing countries where calculi are usually bigger and impacted due to neglected disease, and economic constraints preclude the use of ESWL and flexible ureteroscopy in such cases.

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