Evaluation of Pre-Ureteroscopic Dilatation of Ureteric Orifice for Ureteric Stones Extraction

Abstract

Objective: To evaluate pre-ureteroscopic dilatation of ureteric orifice as a step of ureteroscopy for extraction of ureteric stones. Patients and Methods: Our study included 120 patients with ureteral stones treated by ureteroscopy from February 2024 to March 2025. All patients had ureteral stones up to 15 mm in size, and did not respond to conservative management, or had hydronephrosis secondary to symptomatic ureteral stones and failed ESWL. All underwent semi-rigid ureteroscopic (7.5-9.5 Fr) manipulation. The stone was disintegrated and removed by pneumatic lithotripter and Dormia basket or forceps. Group II also had endoscopic dilatation. Group I had no dilatation. Results: The stones were removed completely in 70 cases (58.3%), 28 cases in-group I and 42 cases in-group II and incompletely (in situ fragmentation) in 20 cases (16.6%) 12 of them in-group I and other 8 in-group II. In these 20 cases, no sizable fragments were seen endoscopically or fluoroscopically. Stone removal failed in 30 cases, 20 from group I, and 10 from group II. Overall stone clearance rate after ureteroscopy was 46.7% in-group I and 70% in-group II (p =0.18). Regarding complications, ureteral mucosal abrasions occurred in 68 cases, 40 of them were in-group I, and 28 cases in-group II. Fifty-six of these cases were managed conservatively with JJ ureteral stents and the remaining 12 cases were managed with ureteric catheters. Ureteral avulsion occurred in two cases from group I during Dormia basket manipulation. Repeat ureteroscopy was needed in 6 cases (2 from group II and 4 from group I) to obtain a stone free status. Fever occurred in 28 cases (12 (20%) from group I and 16 (26%) from group II) after ureteroscopy, 2 had hydronephrosis and were managed conservatively. Conclusions: Pre-ureteroscopic dilatation of the ureteric orifice can be limited to cases with stenotic ureteral orifices, or impacted stones.