title: A New Alternative for Difficult Ureter in Adult Patients: No Need to Dilate Ureter via a Balloon or a Stent with the Aid of 4.5F Semirigid Ureteroscope.
abstract: To investigate the effectivity of 4.5F ultrathin ureteroscope (UT-URS) without any need for active or passive dilation in the treatment of adult patient population in whom ureteral orifices cannot be engaged using conventional URS.
  
  
  
  Among a total of 512 adult patients who had undergone URS between April 2012 and November 2015 in our department for diagnostic or therapeutic purposes, 43 (8.4%) patients required ureteral dilation because we could not engage ureteral orifice. In adult patients in whom we could not engage ureteral orifice with 7.5F and 8F semirigid URS, we tried to complete the operation using 4.5F UT-URS without resorting to dilation. Age and gender of the patients, indication for operation, stone size, location, operative times, laterality of stone(s), stone-free rates, length of hospital stay, and complications were recorded.
  
  
  
  Mean age of the patients was 34.5 ± 11.2 (21-66) years. The patients had undergone operations for ureteral stone (n = 39), unexplained hydronephrosis (n = 2), and ureteral stenosis (n = 2). Mean stone size was 8.2 ± 2.3 (4-18) mm. Mean operative time was 64.2 ± 13.5 minutes. In 37 of 39 patients, a complete stone-free rate (94.8%) was achieved. Mean length of hospital stay was 8.9 ± 5.8 hours.
  
  
  
  It has been demonstrated that in an adult patient population in whom ureteral orifices cannot be engaged using conventional URS, ureteral access could be achieved with 4.5F UT-URS without any need for dilation. At the same time, use of 4.5F UT-URS resulted in an acceptable treatment success and lower complication rates in most of these patients without the need for a second session.
authors.affiliation: 1 Department of Urology, Faculty of Medicine, University of Hacettepe , Ankara, Turkey .
authors.forename: Haluk
authors.initials: H
authors.lastname: Söylemez
authors.affiliation: 2 Department of Urology, Silvan State Hospital , Diyarbakır, Turkey .
authors.forename: Kadir
authors.initials: K
authors.lastname: Yıldırım
authors.affiliation: 3 Department of Urology, Faculty of Medicine, University of Dicle , Diyarbakır, Turkey .
authors.forename: Mehmet Mazhar
authors.initials: MM
authors.lastname: Utangac
authors.affiliation: 1 Department of Urology, Faculty of Medicine, University of Hacettepe , Ankara, Turkey .
authors.forename: Tahsin Batuhan
authors.initials: TB
authors.lastname: Aydoğan
authors.affiliation: 1 Department of Urology, Faculty of Medicine, University of Hacettepe , Ankara, Turkey .
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ezer
authors.affiliation: 3 Department of Urology, Faculty of Medicine, University of Dicle , Diyarbakır, Turkey .
authors.forename: Murat
authors.initials: M
authors.lastname: Atar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003251:Constriction, Pathologic / Q000150:complications; D004867:Equipment Design; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000150:complications; D007902:Length of Stay; D008096:Lithotripsy / Q000379:methods; D017602:Lithotripsy, Laser / Q000379:methods; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D015607:Stents; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014514:Ureteral Calculi / Q000601:surgery*; D014517:Ureteral Obstruction / Q000150:complications; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000295:instrumentation* / Q000379:methods*; D001743:Urinary Bladder; D055815:Young Adult