Retrograde and antegrade access in combination endoscopic treatment of stones in the proximal region of the ureteral duct

Introduction. Surgical treatment of stones in the proximal region of the ureteral duct is a complex clinical issue. Despite the availability of various methods of endoscopic treatment, the use of standard approaches does not allow to achieve the optimal results in a number of cases. The application of elastic ureterostenoscopes as a part of a combined treatment allows to overcome the intraoperative complications and technical limitations of rigid endoscopes, and also to increase the effectiveness of the intervention. Aim of the study. Determination of the peculiarities of surgical intervention during the use of elastic ureterostenoscopes in treatment of stones of the proximal region of the urethral duct. Materials and methods. Over the period of January 2014 -September 2017, 96 patients with stones in the upper third of the urethral duct underwent combined endoscopic treatment in the department of surgery and urology in the clinical and diagnostic center «Zdorovie», Rostov-on-Don. In 23 cases, the elastic ureterostenoscope Karl Storz Flex Xc was used. Results. The application of elastic ureterostenoscopy in retrograde and antegrade access could be divided into three variants: a) the use of elastic ureterostenoscope as a main method; b) additional use of elastic ureterostenoscope due to the technical inability to use a rigid ureterostenoscope; c) endoscopic control using an elastic ureterostenoscope as a finalizing step of surgical treatment. Conslusions. The use of elastic ureterostenoscopes is a minimally invasive method, which is highly effective in treating stones of the proximal region of the urethral duct. In particular, this is important for complex cases, in self-assisted treatment, as well as in a combination with standard methods.