Standard flexible technique

  1. Perform cystoscopy, identify ureteral orifice
  2. Place wire, place 8/10Fr dilator or dual lumen sheath, then place 2nd wire (usually stiffer)
  3. Place sheath - bigger usually = better, and decide length based on patient height, gender (men need longer sheath due to urethra), and stone location (kidney vs ureter)
  4. Place ureteroscope via sheath, identify stone, fragment/dust, then basket residual fragments
  5. Inspect ureter on removal of ureteroscope + sheath
  6. Place stent under fluoroscopic guidance (see above)

Semirigid technique

  1. Place one, possibly two wires into ureteral orifice
  2. Place semirigid ureteroscope into ureteral orifice, find stone for dusting/fragmentation
  3. Tip: if accessing ureteral orifice is difficult, can place ureteroscope over a wire (train-tracking) or flip ureteroscope upside-down (angle of beak may access orifice easier)
  4. Tip: sometimes can irrigate and suction stones out of ureter without basketing
  5. Place stent under fluoroscopic guidance (see above)

Postoperative Management

Pain regimen