الفهرس 
Anatomy of The Lower UreterOnly 14 pages are availabe for public view
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Abstract
The increased prevalence of small urinary calculi has brought about a change in clinical symptoms, with frequent episodes of renal-ureteral colic, persistent pain and hydronephrosis.
In our study we do comparison between extracorporeal shock wave lithotripsy and ureteroscopy in management of lower ureteric calculi.
ESWL offers the least invasive method of managing ureteric stones, especially as it is now generally accepted that ureteric stones should be treated in situ. Although less invasive, other factors must be considered when applying this technique; it may require some time before the patient is stone-free, making frequent out-patient assessments and/or re-treatments necessary.
URS have optimized ureteric stone fragmentation and removal with decreased morbidity. Therefore, the option of ureteroscopic stone removal, although most patients require anesthesia, has become attractive.
At El Agoza police hospital and El Demerdash hospital. from June 2014 to June 2015, a total of 80 patients (56 males and 24 females) with a solitary distal ureteral stone were divided into two groups 40 patients each enrolled in our prospective study. The local ethics committee approved the study protocol.
Patients of the first group were treated by ESWL while patients of the second group were treated with URS
The results of the study were:
Ureteroscopy was shown to be less time consuming than ESWL to reach the stone free state with a mean time of 40 + 9.25 minutes and 62 + 11.68 minutes respectively
IN URS group there were 9 patient don’t need post-operative ureteric stent, in 27 patient ureteric catheter was applied and in 4 cases double ( J ) stent insertion was done .
In this study the stone free rate was considered after two sessions of ESWL or one trial of ureteroscopy
ESWL group: 24 case become stone free after the first session.
10 case become stone free after the second session.
Failure occurred in 6 cases and retreatment is needed.
URS group: 37 case become stone free after one trial.
In one case there was failure to diagnose ureteric orifice.
In the other two cases upward migration of the stone occurred.
ESWL failures were successfully managed by ureteroscopy or a 3’rd session of ESWL, while in ureteroscopy failures cases successfully treated by second trial of URS.
In ESWL group, patients were already at outpatient clinic so there were no admission or hospital stay
While in URS group patients admitted and the periods of stay varies from one day to three days according to the condition of the case.