Access to the Ureter: Rigid Ureteroscopy

Rigid ureteroscopes have a unique advantage over flexible ureteroscopes because of their larger working channels that allow for enhanced irrigation and passage of larger instruments such as biopsy forceps. Indications for rigid ureteroscopy include all distal ureteral conditions including ureteral calculi, tumors, and strictures. Although historically limited to the distal ureter, rigid and semirigid ureteroscopy can be performed throughout the ureter as far proximally as the anatomy safely permits. Modified dorsal lithotomy positioning can assist in advancing a rigid ureteroscope over the psoas muscle. Passage of the rigid ureteroscope through the ureteral orifice can be accomplished with aid of one or two guidewires, and less frequently requires balloon dilation. Given the technical advantages unique to rigid ureteroscopy, the technique should always be considered complementary to flexible ureteroscopic techniques.