TIPS & TRICKS - Access into tight Ureteral Orifices

Accessing a Tight Ureteral Orifice by Using a Semi-Rigid Ureteroscope

Some ureteral orifices are tight and hard to enter with the semi-rigid ureteroscope. Having a guidewire inside the ureter may tighten the orifice even more. In these instances, we have to keep in mind the shape and structure of our instruments.The Olympus semi-rigid ureteroscope has a working channel at the 6 o’clock position of the tip. We can therefore keep a guidewire inside the working channel during entry and we can turn the ureteroscope upside down, with the camera still in neutral position, so that we can have the guidewire at the 12 o’clock position and the whole tip of the ureteroscope under the guidewire. The guidewire at the top can keep the orifice open to some extent and the tip of the ureteroscope does not clash with the orifice wall. We can glide into the ureter. We can then remove the guidewire and continue our journey upwards.