Five types of pathological ureters associated with operative difficulties during the procedure of rigid ureteroscopy

Purpose: To summarize the common pathological types of ureters and their clinical characteristics, which increase operative difficulties and risks during rigid ureteroscopic procedures. Methods: Between January 2001 and May 2011, a total of 126 rigid ureteroscopic procedures performed in ureters were enrolled into this study. Pathological characteristics of ureters were summarized. The manipulation time, intraoperative complications and conditions of surgical conversion were evaluated. Operative tips and tricks to overcome manipulated difficulties were also introduced. Results: High risk ureters were classified into 5 types in terms of their pathological characteristics: type I, calculous strictured ureters; type II, neoplastic strictured ureters; type III, non-congenital benign strictured ureters; type IV, congenital strictured or tiny ureters; type V, dilated and tortuous ureters. The mean manipulation time was 75.7 ± 4.8 minutes. Intraoperative complications appeared in 19 procedures, and 22 procedures were converted to other surgical techniques. Conclusion: These 5 pathological ureter types can increase operative difficulties and risks of rigid ureteroscopic procedures. These tips and tricks may be of value for junior urologists in clinical practice. © 2011 S. Karger AG, Basel.