Flexible ureteroscope

A ureteral double J tube was indwelled routinely 2 weeks before surgery to dilate the ureter. The lithotomy position was taken under general anesthesia. Firstly, ureteroscope (F8.0/9.8 Wolf) was used for ureteroscopic examination, and the guide wire was detained to the pelvis, and ureteral access sheath was placed along the guide wire. Flexible ureteroscope (Olympus) entered the renal collecting system through ureteral access sheath, and stones were fragmented with a Holmium laser lithotripsy device (Lumenis Versa Pulse Power Suite). Ureteral stenting (JJ stent) was routinely indwelled for 2 to 4 weeks.

Before ureteroscopy, almost all patients underwent cystoscopy, CT, and voided urine cytology at our outpatient clinic. Under general (n = 86) or lumbar (n = 80) anesthesia, we initially performed cystoscopy and, thereafter, observed the upper urinary tract using a semi-rigid ureteroscope. Since 1998, flexible ureteroscopy has also been available in our hospital. Although, during the study period, several models of ureteroscopes were used due to the introduction of new models or simply the wear and tear of equipment, a semi-rigid ureteroscope of Richard Wolf (size: 6.0-7.5 Fr, working channel: 4 Fr) and a flexible ureteroscope of Olympus (size: 5.3-8.4, working channel: 3.6 Fr) were mostly used. With the use of 3 Fr forceps, biopsy of any suspicious region was performed, and samples were processed in formalin fixative. Washing urine samples were also collected. In patients with abnormal cytological findings without apparent abnormal radiological findings, random biopsy of the bladder mucosa was also conducted.
In the present study, we examined the diagnostic outcome at the initial ureteroscopy. Thereafter, we collected follow-up data on patients who had been diagnosed without UC of the UUT, and evaluated the incidence of later cancer detection and associated risk factors.