Gaining Access to the Ureter When the Stone is Impacted at the Orifice

The X-ray shows a large stone at the ureterovesical junction. The surgeon is trying to pass a wire through the ureteral orifice. A rather large bulging of the ureteral orifice can be seen due to the impacted stone.
Tip1: A Collins knife is used as a right-angle tool in order to identify the opening of the ureter by compressing the edema.
Tip 2: If the previous maneuver does not help, gradual incisions of the ureteral orifice with manual traction of the opening with the Collins knife will expose the stone.
Then a safety wire is placed to ensure access to the whole ureter. In the next step the laser lithotripsy can be performed as usual.

access to urether,