"Difficult Entry into the Ureteric Orifice"

追加: 2026-05-28

[00:00:00]Here is a case where the ureteric orifice was very difficult to identify at the trigone and also the guidewire was not going because it was medially situated. Such situations occur very commonly in the private practice. For juniors it will be nightmare. That's why some tips I'm sharing in this video. Now I am sharing the video. Here is a case of difficult entry into the ureteric orifice, stone in the lower ureter, left side. When you went inside, normally ureteric orifice is seen within 1 minute.

[00:00:35]Anybody will try to go. If the ureteric orifice itself is not seen, it's a matter of concern.

[00:00:42]The most important thing is you enter with urethroscope.

[00:00:46]So, with when you're doing urethroscope, don't make the blood to come in the bladder neck. If the blood comes, you cannot do. Then put a removable guidewire, medium size 0.025, and try to slowly do poking wherever you want. This is a difficult situation. You don't know where is the orifice.

[00:01:05]If you keep on looking at the trigone in a distended bladder, I see now now now we got hint. But orifice is too medial central in the trigone and the guidewire doesn't go.

[00:01:18]Then if if you perforate with guidewire repeatedly, blood will come and you cannot do that also.

[00:01:23]Take directly urethroscope with high flow, either small or medium urethroscope. Now see, I have withdrawn the guidewire.

[00:01:32]Now this this will not work out for a long time because that curvature it will not negotiate and it will perforate.

[00:01:38]So, secret is go and abut the 9:00 position and 90° your body language you change and turn, you will enter into the ureter. That means opposite leg you have to abut and turn. Once you enter, it is same. Second thing, immediately don't come out. Go above the stone and make the ureter a little straight structure.

[00:02:00]This is a stone. Immediately, in fact, this is I could not show. You cross the stone, you wait for 5 minutes, and this is also wrong. And then do the surgery.

[00:02:10]This is actually triprong application with the drawing. In a tight medial ureter, you should not do it. This is absolutely wrong. We get tempted, that's why I'm sharing. No, this can avulse the mucosa. The best part is break the stone into two pieces. Again, I am using the basket. That is also not correct. But I had a feeling that the it will come out.

[00:02:29]It has come out. Ideally, you should make two three pieces. Or else just leave and put the stent and come out is also very good. The stone will definitely pass out. Or else you take 5 minutes to go inside. By that time, ureteric orifice might have dilated way, way more than what it is now. This is the message. The main important one want to share is when the ureteric orifice is tight, go and hit the on the left side 9:00 part of the ureter and get the space. Turn 180° towards the 3:00. Then you will get the lumen. Thank you.