The ureters are thin tubes which connect the kidneys with the urinary bladder. Ureteroscopy is the process of examining the ureters by means of a specialized endoscope known as the ureterosope. The access is gained to the ureters through the urethra and the urinary bladder. The ureteroscope is equipped with illumination and has the capability to transmit images of the inside of the ureters, which can be studied by means of an external lens.
In the early days, rigid rod-lens ureteroscopes were used. These were rather large in diameter (about 12F, where 1mm = 3F). In 1964, the first flexible fiber optic ureterosope was developed which was an attractive alternative to the rigid or semi-rigid variety. In the early 1980s, the improved flexible fiber optic ureteroscope was developed by Bagley, Lyon and Huffman.
Today, both flexible and rigid ureteroscopes are available with an average diameter of about 7.5F. They are used for the treatment of upper urinary tract conditions such as urothelial malignancies, stones, bleeding lesions and stricture disease.
Ureteroscopy can be used for diagnostic and therapeutic purposes. Diagnostic ureteroscopy is done for the examination of the upper urinary tract whereas therapeutic ureteroscopy is done to perform remedial treatment. Nowadays, wireless ureteroscopy is possible which results in minimum trauma to the region being viewed. Previously, dilation of the urethra used to be necessary, but today ureteroscopy is done without this procedure.
Whether diagnostic or therapeutic, ureteroscopy is usually performed for the detection and treatment of kidney stones. It is also useful in the treatment of stricture disease and urothelial tumors. Ureteroscopy is a very versatile technique which is very useful for treating pediatric patients and pregnant women, with no adverse side-effects.
Mentioned below are the two main types of ureteroscopy:
Diagnostic Ureteroscopy: This is an investigative technique used for detecting abnormalities of the upper urinary tract. An ureteroscope is inserted into the ureters and the entire region is viewed. The purpose is to map the renal collection system. Depending on the findings, further treatment for the patient can be planned.
Therapeutic Ureteroscopy It is used for treating of stones, tumors and stricture disease. The procedure may be a simple salvage procedure or it may be more elaborate as in the case of extracorporeal shockwave lithotripsy. The ureteroscope is modified to adapt to the technique being used. This procedure is extremely effective in the treatment of extremely young patients and pregnant women.
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