Analysis and strategies of difficult accesses with rigid transurethral ureteroscopy

Objective To analyze the reasons of difficult accesses by manipulating rigid transurethral ureteroscopy and to find out the corresponding solving methods.Methods 1270 cases treated under transurethral ureteroscopy were evaluated from March 2007 to July 2011.Results The difficuties in the ureteroscopy insertion occurred in 145 cases,92 cases can be achieved successfully by rotating the ureteroscopy with skil1.17 cases were done by ureteral dilatation or Holmium:YAG laser endoureteromy,33 cases were treated by indwelling double J tube,3 cases were converted to open surgery.The difficuties in the ureteroscopy exsertion occurred in 12 cases,8 cases were successful for pulling out ureteroscopy,4 cases were converted to open surgery.Conclusion Improving operational techniques can overcome the difficult accesses with rigid transurethral ureteroscopy,and sometimes abandoning maybe is the key point to avoid severe ureter injuries.