title: Acute dilatation of intramural ureter for ureteroscopy: railway technique.
abstract: OBJECTIVE
  To assess the safety and efficacy of acute dilatation of THE intramural ureter for ureteroscopy by the railway technique.
  
  
  METHODS
  Between January 2000 and December 2004, 400 consecutive ureteroscopic procedures were performed, among which 15 male and 5 female patients (5%) with an average age of 40 years (range 25-65 years) underwent acute dilatation of the intramural ureter by the railway technique A guidewire is placed into the ureter, and a 3F ureteral catheter is passed through the working channel of the ureteroscope (8.5F-10F) for 3 to 5 cm into the ureter. The ureteroscope is rotated so that it lies between the guidewire (outside) and the ureteral catheter (inside) and advanced between the guidewire and the ureteral catheter like riding over a railway. Postoperatively, no double-J stent was used. The mean follow-up was 25 months (range 6-60 months). An intravenous urogram and voiding cyctourethrography were obtained at 3 months, and ultrasonography was performed every 6 months in the first year and every 2 years after ureteroscopy in all 20 patients.
  
  
  RESULTS
  Ureteral access was achieved with the railway technique in all 20 patients. Perforation or intramural false passage of the ureter did not appear. Follow-up imaging showed no distal-ureteral stricture or vesicoureteral reflux.
  
  
  CONCLUSIONS
  Acute dilatation of the intramural ureter by the railway technique is cost effective, safe, easy, rapid, and predictable. This time-saving technique often removes the need for balloon dilatation of the distal ureter.
authors.affiliation: Department of Urology, Chamran Hospital, Islamic Azad University, Tehran Medical Branch, Hamadan University of Medical Sciences and Shahid Beheshti University of Medical Sciences, Tehran, Iran. hgholamrezaie@unrc.ir
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Gholamrezaie
authors.forename: Ali
authors.initials: A
authors.lastname: Shahrazad
authors.forename: Ali
authors.initials: A
authors.lastname: Tabibi
authors.forename: S Habib Mousavi
authors.initials: SH
authors.lastname: Bahar
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D004106:Dilatation / Q000295:instrumentation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D016896:Treatment Outcome; D014463:Ultrasonography; D014513:Ureter / Q000000981:diagnostic imaging / Q000473:pathology*; D014515:Ureteral Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000379:methods*