Transurethral ureteroscopy in women: A ready addition to the urological armamentarium

Ureteroscopy via the transurethral route and limited to the terminal ureter in women lends itself to inclusion in the urological armamentarium. The technique requires no equipment other than routine urological instruments and makes endoscopic inspection, biopsy and resection within the distal ureter possible. The procedure is done with the patient under anesthesia, following urethral dilation to 32F. With the aid of a small caliber cystoscope, 20F or smaller, straight Jewett sounds can be passed into the urethra alongside the cystoscope and directed under cystoscopic control into the ureteral orifice. The orifice is then dilated gently, using 12, 14 and, if necessary, 16F sounds. One of the standard pediatric cystoscopes can then be introduced easily into the orifice. Currently, the technique is being used routinely in women with transitional cell carcinoma involving the ureteral orifice or intramural ureter. In 1 patient a tumor arising from within the lower ureter was resected successfully using a pediatric resectoscope.