Outcome of ureteral distensibility on the success of ureteroscopy: A prospective hospital-based descriptive study

Abstract Introduction “Difficult ureter” is a known problem that increases the complications during ureteroscopy. Objective To categorize ureters according to their distensibility, and to determine whether ureteric distensibility is associated with the success of ureteroscopy and its complications. Subjects and methods Between January 2010 and September 2012, we tested ureteral distensibility in 306 patients who had a unilateral single radiopaque ureteral stone, 6–20 mm in diameter. Ureteral distensibility was classified into two categories according to the maximum size of a ureteral dilator that could be introduced before ureteroscopy: non-distensible ureters, which admitted a dilator up to 10 Fr and distensible ureters, which admitted a dilator >10 Fr. Correlations between distensibility and the success rate and complications of ureteroscopy were determined. Results Overall, 102 patients (33.3%) had non-distensible ureters and 204 (66.7%) had distensible ureters. Distensibility was correlated with the success of ureteroscopy because initial ureteroscopy failed in 38.2% of non-distensible ureters. Ureteroscopy was successful in all distensible ureters. The incidence of ureteric injury was higher in non-distensible ureters than in distensible ureters. Conclusions Our results suggest that ureteric distensibility should be tested before ureteroscopy. Primary ureteroscopy is recommended in distensible ureters because of its low complication rates and favorable outcome. Pre-stenting may be necessary before ureteroscopy in non-distensible ureters; secondary ureteroscopy may be safer and more feasible in these settings.