title: [Update in the management of ureteral lithiasis: Semirigid and flexible ureterorenoscopy.]
abstract: OBJECTIVE
  The contribution of therapeutic ureteroscopy done by Perez Castro in 1980 varied the management algorithm for ureteral lithiasis worldwide. The techniques of Retrograde Ureteroscopy and transrenal antegrade ureteroscopy led to the abandonment of open surgery for the treatment of ureteral lithiasis. Only Shock wave lithotripsy has maintained similar success rates in selected cases.
  
  
  METHODS
  Descriptive analysis of the semirigid and flexible ureteroscopy techniques performed in our department over the last 10 years giving detail on the technique and safety tips to increase the efficacy and efficiency of ureteroscopy. 4,533 semirigid ureterorenoscopies and 980 flexible ureterorenoscopies were performed between January 2005 and July 2016.
  
  
  RESULTS
  We registered 82% lithiasis elimination on a single operation with a 1,8% overall complication rate for complications higher than Clavien III. We registered 108 urinary sepsis episodes with 2 deaths secondary to massive shock. One patient required supra-selective renal embolization due to renal rupture and hemorrhage after URS. Four patients have required open or laparoscopic surgical repair Five patients required nephrectomy due to absent function of the renal unit after URS and 2 for complete ureteral avulsion on ureteroscope extraction.
  
  
  CONCLUSIONS
  Semirigid ureterorenoscopy enables the elimination of ureteral lithiasis on a major ambulatory surgery regimen with an acceptable complication rate and a low rate of ancillary measures. Flexible ureteroscopy has resolved intrarenal lithiasis of up to 2 cm, being a substitute for percutaneous nephrolithotomy for these cases.
authors.affiliation: Unidad de Litiasis Renal y Endourología. Servicio de Urología. Hospital Universitari de Bellvitge. Barcelona. España.
authors.forename: Carlos
authors.initials: C
authors.lastname: Torrecilla Ortiz
authors.affiliation: Unidad de Litiasis Renal y Endourología. Servicio de Urología. Hospital Universitari de Bellvitge. Barcelona. España.
authors.forename: Sergi
authors.initials: S
authors.lastname: Colom Feixas
mesh_terms: D004867:Equipment Design; D006801:Humans; D013997:Time Factors; D053039:Ureterolithiasis / Q000601:surgery*; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000379:methods* / Q000706:statistics & numerical data