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Background & Objective: Transureteral lithotripsy is an effective procedure in lower ureteral stone. This study was done to evaluate lithotripsy method in pediatric ureteral stones in Mashhad’s Imam-Reza Hospital. Materials & Methods: In our institute 38 patients went under ureteroscopy and lithotripsy for ureteral stones. Mean age in our patients was 6.8 years (Range 2-13 years). 16 patients were male and 22 patients were female. The mean stone size was 7 mm (Range 6-16 mm). Ultrasonography and KUB or IVP was performed in all cases. After general anesthesia and cystoscopy guide wire introduced in ureter, ureteroscopy were performed for lithotripsy used ultrasound pneumatic or electrohydrolic. Results: Stone were located in the distal ureter in 32 patients, in the midureter in 4 and in the proximal ureter in 2 cases. Ureteroscopy was successfully in 35 cases. Lithotripsy was used: Ultrasound, electrohydrolic or pneumatic. We were unable to introduce the ureteroscope into the ureter in 3 patients. In 3 patients stone migrated to the kidney after ureteroscopy. Then, they candidated for ESWL. Stone free was done in 32 cases (85%). A complication was 25% and treated with medical treatment. Conclusion: Our investigation demonstrates the high success rate ureteroscopy in pediatric group especially with a small caliber ureteroscope. Ureteroscopy should be considered the first choice for treatments of calculi in the distal ureter in children.

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Background & Objective: Ureteroscopic lithotripsy is a prevalent and minimally invasive modality for the management of ureteral calculi. This study was done evaluate to the incidence and management of major complications in 3900 cases of ureteroscopic lithotripsy. Materials & Methods: This descriptive – cross sectional study was done on 3900 cases of ureteroscopic lithotripsy in Isfahan – Iran, during 1994-2006. All complications and treatment of patients recorded. Results: Major complications occurred in 29 cases either intraoperatively or postoperatively (1 to 30 days), including ureteral perforation in 16 cases, ureteral avulsion in 7, urinoma in 4 and perinephric abcess in 2. Two cases of uretral avulsion at the ureterovesical junction underwent ureteroneocystostomy. The other 5 cases were managed by psoas hitch together with Boari flap, transureteroureterostomy, open placement of double J stent with omental wrap, and ureteroscopic placement of double J stent and ileal substitution. Urinomas were managed by percutaneous drainage of the urinoma and placement of double J stent (3 cases) and open surgery (1case). Two cases of perinephric abscess were managed by open surgical procedure and double J placement. Fourteen cases of ureteral perforation were managed by ureteroscopic double J placement and in 2 cases by open surgery. Conclusion: Ureteroscopic lithotripsy is an excellent and minimally invasive modality for the management of ureteral calculi. Major complications may occur, emphasizing the need for constant vigilance and precautionary measures.

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Background and Objective: Intercostal and supracostal access tract are usual access for percoutaneous nephrolithotripsy (PCNL) for upper calices stones. But pleural complication of these tracts are high. This study was done to evalute percutaneous nephrolithotomy (PCNL) of upper calices with subcostal access. Materials and Methods: Seventeen patients (12 males, 5 females) with stones limited to upper calices with diameters of 11-27 mm and 1-5 in numbers, candidated for PCNL. Ultrasonography and intravenous urography were performed for all patients prior to surgery. In all patients PCNL performed in prone position and access is made at prolonged and deep inspiration from subcostal with fluoroscopic guidance. Following access to upper calices, guide wire inserted and dilatation of tract up to 28 or 30 Fr informed. After insertion of 28 or 30 Fr Amplatz sheat nephroscopy performed. Results: Two patients excluded and finally 15 patients were accounted. In 15 patients subcostal access performed successfully (88.2 %) . In 5 patients stones of less than 10 mm extracted with grasps. In 10 patients after pneumatic lithotripsy, particles of tones removed. 11 patients rendered stone free (73.3%). 4 patients had residual stones of greater that 5 mm in minor calices that in 3 patients after single ESWL resolved. 3 patients needed infandibular dilatation for complete stone extraction. No infection, transfusion, pneumothorax, hydrothorax, respiratory discomfort in operation and post operation period were seen. In one patient a perirenal collection of liquid with diameter of 5 cm was detected. Perirenal collection of liquid was removed with preventional treatment and antibiotics regiments. Conclusion: PCNL with subcostal access for upper calices stones is a feasible and safe with low complication and can be performed instead of supracostal access tracts.