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General tips for a simpler and safer ureteroscopy

Sunil Kumar

A preliminary diagnostic cystoscopy is performed and a guide (safety) wire passed up the ureteric orifice under fluoroscopy. A retrograde pyelogram could be performed at this stage if necessary, particularly if there is any ­problem with free passage of the wire. The cystoscope is now withdrawn, making sure that the safety wire is not dislodged. One of the important steps at this stage is to leave the bladder empty; if the bladder is full, the ureteric orifices are displaced laterally, making access into the lower ureter more ­difficult. The safety wire needs to be placed in its sheath and clipped away, ensuring that there are no dangling loops that may get caught during the procedure which may lead to its inadvertent dislodgement. Prior to inserting the ureteroscope, it is important to make sure that all attachments are in the right place.

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