title: Large benign prostatic hyperplasia means impossible ureteroscopy: myth or reality?
abstract: OBJECTIVE
  We intended to ascertain the true role played by large-size prostatic glands with BPH in impeding ureteroscopy; since no such impediment was experienced by the authors, we then listed the most frequent obstacles to ureteroscopy, contrary to what is commonly reported in literature.
  
  
  METHODS
  Endourological reports on a series of 2,147 diagnostic or therapeutic ureteroscopies were examined, together with the patients' clinical records. Male patients accounted for 1,288 cases. In 45 cases, the operators found the prostate so enlarged as to be worthy of note. In 9 of these cases, the procedure was performed bilaterally; thus, a total of 54 ureteroscopies was undertaken in patients with enlarged prostates or large median lobes.
  
  
  RESULTS
  None of the surgical reports indicated that the ureteroscopic procedure was hindered by an enlarged prostate. On the other hand, the most frequent causes preventing ureteroscopy are, for both male and female patients, some types of tumor: uterine, ovarian, ureteral, bowel, bladder and prostate cancer, and inflammation.
  
  
  CONCLUSIONS
  Benign prostatic hypertrophy (BPH) is not of itself an impediment to ureteroscopy when it is performed by an expert operator equipped with suitable instruments. On the other hand, tumours of the female reproductive system, as well as bladder and prostate tumours and serious inflammations and infections may make the procedure impossible or cause serious problems during its performance, at times requiring combined antegrade and retrograde maneuverings. At the root of this obstacle lies neoplastic or inflammatory infiltration and stiffening which attaches itself to the organs and hardens their connections. In the case of BPH, we do not find infiltration, but only a dislocation, which can be compensated by means of a few technical stratagems. Some interesting expedients in the incannulation of difficult meatuses were already suggested in 1914 by Heitz-Boyer and Marion.
authors.affiliation: Clinica Urologica e Scuola di Specializzazione in Urologia, Dipartimento di Scienze Chirurgiche e Trapianti d'Organo, Università degli Studi di Cagliari, Ospedale SS. Trinità, Cagliari, Italy.
authors.forename: R M
authors.initials: RM
authors.lastname: Scarpa
authors.forename: A
authors.initials: A
authors.lastname: De Lisa
authors.forename: D
authors.initials: D
authors.lastname: Porru
authors.forename: E
authors.initials: E
authors.lastname: Usai
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011470:Prostatic Hyperplasia / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017211:Treatment Failure; D018666:Ureteroscopy / Q000379:methods*